19 April 2021
Providing healthcare at home to selected older people who experience a deterioration in health rather than in hospital could reduce pressure on hospital resources and be less disruptive to older people.
- In this study, patients who received ‘Hospital at Home’ care had just as good outcomes six months later, as those who were admitted to hospital.
- The study also found higher levels of patient satisfaction with Hospital at Home care.
A new study, funded by the NIHR and led by researchers from the Nuffield Department of Population Health at the University of Oxford shows that caring for a select group of vulnerable, older people at home can improve patient outcomes, while reducing pressures on hospitals. The results are published today in Annals of Internal Medicine.
The past year has highlighted the chronic shortage of hospital beds in the UK and other countries. Even in pre-pandemic times, one of the greatest challenges the NHS faces is the growing older population1, who are being admitted to hospital in increasing numbers, for instance due to a fall or sudden illness.
Besides putting pressure on hospital resources and budgets, there are concerns that this may not be the best place to care for older people. There is evidence that, for older people, hospital admission may cause acute confusion (delirium), reduce mobility and accelerate the transition to residential care.
An alternative to hospital admission is a ‘Hospital at Home’ arrangement, where hospital-standard care is provided to patients in their homes. As in a hospital ward, patients have access to a geriatrician and multi-disciplinary team, medicines, oxygen and intravenous treatment; and they can be transferred to hospital if required. Hospital at Home models are already operating in a few areas of the UK, and surveys have consistently found that most older people prefer to receive care at home. Until now, however, there was no clear evidence on whether Hospital at Home care affects patient outcomes.
This was investigated using a randomised trial involving over 1000 older participants3 (average age 83 years) recruited between March 2015 and June 2018 across the UK. Participants had been referred for hospital admission for many different reasons that included acute functional decline or infection. Those who agreed to take part in the trial were randomly assigned to either hospital admission or Hospital at Home treatment.
After six months, the results of the study found:
- There was little difference in the proportion of participants living at home: 78.6% participants in the Hospital at Home group were living at home, compared with 75.3% participants in the hospitalised group.
- There was little difference in the proportion of patients who had died: 16.9% of participants in the Hospital at Home group had died, compared with 17.7% in the hospital group.
- Participants in the Hospital at Home model were slightly less likely to be in long-term residential care (5.7% vs 8.7%).
- There was no difference in cognitive impairment, impact on daily living activities or new chronic conditions.
- In addition, after one month participants in the Hospital at Home model were slightly less likely to develop acute confusion (delirium) (1.7% vs 4.4%).
This is the largest study to date on Hospital at Home care. According to the study leaders, these results indicate that hospital level care in the home is just as beneficial for a selected group of older people as hospital care. This type of care could provide an additional service that ultimately relieves pressure on hospital beds, and avoids unnecessary stress and disruption for older people.
The study also reported higher levels of patient satisfaction with Hospital at Home care. In particular, Hospital at Home scored more highly regarding the length of time waiting for care to start, contacting staff, being involved in decisions and discussing further health or social care services.
The Hospital at Home model is designed to offer complete, holistic care support. Patients are assessed by a geriatrician, besides a multidisciplinary team that includes social workers, dieticians, and occupational therapists, who draw up a personalised care plan. It is not yet known whether Hospital at Home care is cheaper than hospital-based care, but the research team are investigating this in an economic analysis.
Study lead Professor Sasha Shepperd from the Nuffield Department of Population Health, University of Oxford, said: ‘Our study has produced valuable information to guide policy and healthcare providers. Up until now, nobody has known whether to fully invest in Hospital at Home nationwide, or to focus on hospital care. Whether it is more expensive or not, if it means the same or better health outcomes and less disruption for certain patients then we should consider doing it.’
Notes to editors
The study is published in Annals of Internal Medicine. The abstract will be publicly available once the embargo lifts: https://www.acpjournals.org/doi/10.7326/M20-5688
For media requests, including interviews, a PDF copy of the complete study, or a graphical abstract, contact Dr Caroline Wood: firstname.lastname@example.org
For more information about the study, visit https://www.hahstudy.org/
The study was funded by The National Institute for Health Research Health Services and Delivery Research Programme.
Background research which informed this study:
- Currently there are around 12 million people in the UK who are aged 65 years or above, of which 8.6 million are aged over 85 years. By 2030, it is estimated that one in five people in the UK will be aged 65 or over. Source: Later Life in the United Kingdom, 2019. AgeUK.
- Inouye, S.K., Westendorp, R.G. and Saczynski, J.S., 2014. Delirium in elderly people. The Lancet, 383(9920), pp.911-922.
- The study involved 1055 older participants who had been referred for a hospital admission. Patients with more severe health needs were not included in the study, for instance people who had experienced a heart attack or suspected stroke, those at end of life requiring palliative care or those needing urgent surgical treatment.
The University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the fifth year running, and at the heart of this success is our ground-breaking research and innovation. Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.
About the Nuffield Department of Population Health
The Nuffield Department of Population Health (NDPH) is a world-leading research institute, based at the University of Oxford that investigates the causes and prevention of disease. NDPH has over 750 staff, students and academic visitors working in a number of world-renowned population health research groups, including the Cancer Epidemiology Unit (CEU), Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), and the MRC Population Health Research Unit (MRC PHRU), and other groups working on perinatal epidemiology, public health, health economics, ethics and health record linkage. It is also a key partner in the Oxford University Big Data Institute. For further information, please visit www.ndph.ox.ac.uk
About the National Institute for Health Research (NIHR)
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.