Short summary

The study is a 3-year PhD project concerning the elderly medical patient. It's divided into two parts. The first part is a prospective cohort study of the clinical characteristics of elderly patients acutely admitted to the medical emergency department. How do they present themselves? What factors is predictive of a poor outcome?

The second part of the study is a case study on the feasibility of home hospitalization of the elderly medical patient. How can such a setup be made so it's safe and patients are provided the same treatment as where they admitted to the hospital. How does it affect our health system and what is the cost of home hospitalization?

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Rationale

The elderly population has significantly higher risk of health problems. Ensuring high-quality and efficient emergency care for the growing number of elder will require investigation of the clinical characteristics of this large and diverse group. It is well known that frail older adults with acute illness often lack the classical symptoms found in younger person. They have atypical, non-specific symptoms to acute illness. This makes the elderly patient medically complex and difficult to treat. The purpose of the first part of the study is to describe what characterize the elder patient and what factors may predict adverse outcome.

For many older patients hospitalization can result in complications unrelated to the problem that caused the admission. Delirium, hospital acquired infections and functional decline are examples of such complications. Previous studies suggest that incident delirium and functional decline could be reduced if the patients are cared for and treated in a hospital at their own home. In the future there will also be fewer hospitals beds. If it is feasible, beneficial for the patients and the health organization the solution could be to hospitalize and treat elderly people at home surveyed by medico-technological monitoring. The purpose of the second part of the study is to investigate the possibility of hospital at home supported by technique.

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Description of the cohort

Part 1:

Patients over or equal to 65 years acutely admitted to the department of geriatric medicine via the department of emergency medicine (FAM, OUH)
Admitted during a 12 month (1-11-2013 to 31-10-2014) period and followed up 12 month after discharge. 

Part 2:

Patient over or equal to 65 years acutely admitted to the department of geriatric medicine via the department of emergency
Patients suitable to hospitalization at home and able to give informed consent.

Data and biological material

Part 1:

Basic description: (Mean age, gender, social status and living conditions, medication (ATC-code), weekday and admission time)
Clinically: Triage category and chief complaint, comorbidity, activity of daily living, cognitive function, physical function, frailty index
In hospital: Length of stay, use of hospital services
After discharge: Discharge diagnosis, living conditions after discharge
Follow-up: Readmission, mortality, Institutionalization, amount of social service given until 1year.

Part 2:

The Model for Assessment of Telemedicine will be used. Data will be collected and analyzed to cover all seven domains of the model:

1. Health problem
2. Safety
3. Clinical effectiveness
4. Patient perspectives
5. Economic aspects
6. Organizational aspects
7. Socio-cultural, ethical and legal aspects.

Collaborating researchers and departments

Department of Geriatric Medicine, Odense University Hospital

Research Unit of Emergency Medicine, Odense University Hospital

Centre for Innovative Medical Technology (CIMT), Odense University Hospitaland University of Southern Denmark

Centre for Applied Health Services Research (CAST) Laboratory for tele health and tele rehabilitation, Aalborg University Patient@home, University of Southern Denmark