Search

Context: Care home residents in the UK care homes account for almost 1.5 million emergency bed days each year. Avoidance of unnecessary hospital transfers benefits residents, and reduces demand on the healthcare systems but is difficult to implement. Objective: We synthesized evidence on interventions that influence unplanned hospital admissions or attendances by care home residents. Study design: This is a Systematic Review of Randomised Controlled Trials. Dataset: PUBMED, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2021, building on a review published in 2013. Population studied: Care home residents over the age of sixty-five years old. Intervention: Interventions that influence (decrease or increase) acute hospital admissions or attendances from care home residents. Outcome measures: Hospitalization, Emergency Department Attendance, and Rehospitalization. Results Thirty-eight randomized studies were included in this review. A narrative synthesis was conducted and the weight of evidence was described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalizations from care homes. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination, and enhancing access to intravenous therapies in care homes. Factors that affect hospitalization and emergency department attendances of care home residents are complex. This review supports the already established use of advanced care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare utilization across the care home population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare utilization., Presenters Ben Searle, MBBS, MSc, MRCGP, Robert Barker, Daniel Stow, Gemma Spiers, Fiona Pearson, Barbara Hanratty, MBChB, MPH, MSc, [...]

Background: Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. Methods and findings: This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6–8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Conclusions: Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus. [ABSTRACT FROM AUTHOR]

Background Cold homes are associated with an increased risk of adverse health outcomes for older people. To mitigate this risk, homes need to be heated to an appropriate temperature. This review aims to identify interventions designed to improve heating and temperatures within homes and summarize its impact on health, health service utilization and cost effectiveness. Methods A rapid review was conducted. Studies assessing the effects of structural, financial, or behavioural interventions designed to improve home temperatures of residents aged 18+ years were eligible. Searches were carried out in four databases. A search for grey literature, and backward and forward citation searching were performed. Data were summarized in a narrative synthesis and mapped using EPPI-Reviewer and EPPI-Mapper software. Results Eighteen studies reported across 19 publications were included. Structural interventions were associated with better mental health and quality of life, a reduction in health service utilization, and improvements in satisfaction with internal home temperature, social interactions and financial difficulties. The impact on physical health outcomes varied by age, gender and long-term conditions. Evidence about the impact of behavioural interventions was inconsistent. Conclusion Structural improvements to increase home temperatures may offer the potential to improve some aspects of health. However, the impact on physical health, including which groups are most likely to benefit, is unclear. Key gaps include the lack of evidence about the impact of financial interventions, and the impact of all types of interventions, on quality of life, mortality and costs. [ABSTRACT FROM AUTHOR]