Hospital at home care for older patients with cognitive impairment and an acute medical illness

Hospital at Home care aims to avoid hospital-associated geriatric syndromes and nursing home admission in older patients with cognitive impairment by providing hospital care in a patients’ own environment. Hospital at Home is a monocenter, randomized, unblinded feasibility trial in older patients with cognitive impairment referred to the emergency department of the hospital for an acute medical illness. Eligible patients will be randomized either to hospital care in their own environment, Hospital at Home care, or usual hospital care. The intervention consists of hospital level care provided at the patients’ own home. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment.

The aim of the study is to assess the feasibility of conducting a randomized controlled trial in terms of recruitment, use and acceptability of Hospital at Home care, and to evaluate the quality of care and the advantages and disadvantages of the Hospital at Home care program in comparison to usual hospital care.

Data will be collected at baseline at the emergency department, during admission (in Hospital at Home or hospital), at discharge and at three and six months following randomization, plus or minus two weeks.

After informed consent is obtained, the participant completes two brief cognitive tests and participant and caregiver complete the baseline assessment. Subsequently, randomization takes place to either (a) H@H-intervention; translocation of care from the hospital to a participants’ home or (b) Control; usual hospital care. In case of nonparticipation, reasons for declination, date of birth, sex and the presence of a caregiver are reported, if possible.

Participants allocated to Hospital at Home will receive hospital level care in their own home under responsibility of the hospital. Hospital at Home care will be described in care protocols.