The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel.

BACKGROUND: A model of hospital-at-home services called the Home Care Unit ("the unit") has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model. METHODS: A retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit. RESULTS: The study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001). CONCLUSIONS: Treatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.

Intensive rehabilitation after pelvic and hip fractures: a comparative retrospective study.

Purpose: Pelvic fracture (PF) is common, especially among older patients, and its prevalence increases over time. In contrast to hip fracture (HF), the literature on rehabilitation after PF is scant, mandating a study of the outcomes of rehabilitation in patients with PF. The present study compared patients who underwent intensive rehabilitation following HF or PF. Methods: A retrospective study of patients 65 years of age and older who underwent intensive rehabilitation in the Geriatrics Department. Data were collected on patients with PF, while data on patients with HF were taken from an earlier study. All patients in both groups suffered from low-energy trauma. Rehabilitation outcomes were measured using the Montebello Rehabilitation Factor Score-revised (MRSF-R). Results: 144 PF patients were compared with 138 HF patients. The mean age of the patients in the HF group was 82.5 ± 7.1 compared to 81.5 ± 6.9 in the PF group (p = 0.230). Females comprised 77.5% of the patients in the HF group and 90.3% in the PF group (p = 0.04). All patients in the HF group underwent surgical repair of their fracture, while all patients in the PF group had non-surgical treatment. More patients in the HF sample had a nursing caregiver prior to the fracture (92.0% vs. 60.4%, p < 0.001), had a higher Charlson Co-morbidity Index total score (2.1 ± 1.9 vs. 1.6 ± 1.7, p = 0.13), developed more delirium (21.7% vs. 8.3%, p = 0.16), more infections (29.0% vs. 11.1%, p < 0.002), and more cardiovascular complications (23.9% vs. 5.6%, p < 0.001) during hospitalization. They had longer hospital stays (20.9 ± 7.5 vs. 18.2 ± 7.7 days, p = 0.0007), and had a higher mortality rate (13.8% vs. 6.3%, p = 0.037) over the first year following the fracture than the PF group. A similar rate of patients in both groups (64.5% vs. 60.4%, p = 0.483) had successful intensive rehabilitation. In the PF group only cognitive state was an independent predictor of successful rehabilitation, with each additional point in the Mini Mental State Examination (MMSE) increasing the patient's chance of reaching an MRFS-R score ≥ 50 by 20.5%. Conclusion: Despite slightly different characteristics in the two groups, the results of intensive rehabilitation were similar. Cognitive state was the only independent factor that affected achievement of a better rehabilitation outcome. With the increasing rate of PF, more studies should focus on rehabilitation in this patient population.

A retrospective analysis of the sentence writing component of the Mini Mental State Examination: cognitive and affective aspects.

BACKGROUND: One of the components of the Mini Mental State Examination (MMSE) is the request to write a sentence. We investigated the relationship between the characteristics of the written sentence of the MMSE and the cognitive and affective status of elderly patients. METHODS: The characteristics of the sentence were compared to the total MMSE score, sociodemographic characteristics, tests evaluating cognition and affective status, and diagnoses. RESULTS: The number of words was significantly associated with the degree of cognitive impairment, whereas the emotional polarity of sentences and concerns about health were associated with depression. CONCLUSIONS: Characteristics of the MMSE sentence may provide important additional information regarding both cognition and affect when assessing older people.