Age and Ageing Advance Access originally published online on October 20, 2005
Age and Ageing 2006 35(1):53-60; doi:10.1093/ageing/afi206
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Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial)
1 Post Acute Care Services, Prince of Wales Hospital, Randwick, Sydney, New South Wales 2031, Australia
2 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
3 Department of Health, North Sydney, New South Wales 2060, Australia
Address correspondence to: G. A. Caplan. Tel: (+61) 2 9382 2470. Fax: (+61) 2 9382 2477. Email: g.caplan{at}unsw.edu.au
Background: delirium is a frequent adverse consequence of hospitalisation for older patients, but there has been little research into its prevention. A recent study of Hospital in the Home (admission substitution) noted less delirium in the home-treated group.
Setting: a tertiary referral teaching hospital in Sydney, Australia.
Methods: we randomised 104 consecutive patients referred for geriatric rehabilitation to be treated in one of two ways, either in Hospital in the Home (early discharge) or in hospital, in a rehabilitation ward. We compared the occurrence of delirium measured by the confusion assessment method. Secondary outcome measures were length of stay, hospital bed days, cost of acute care and rehabilitation, functional independence measure (FIM), Mini-Mental State Examination (MMSE) and geriatric depression score (GDS) assessed on discharge and at 1- and 6-month follow-up and patient satisfaction.
Results: the home group had lower odds of developing delirium during rehabilitation [odds ratio (OR) = 0.17; 95% confidence interval 0.03–0.65], shorter duration of rehabilitation (15.97 versus 23.09 days; P = 0.0164) and used less hospital bed days (20.31 versus 40.09, P
0.0001). The cost was lower for the acute plus rehabilitation phases (£7,680 versus £10,598; P = 0.0109) and the rehabilitation phase alone (£2,523 versus £6,100; P0.0001). There was no difference in FIM, MMSE or GDS scores. the home group was more satisfied (P = 0.0057).
Conclusions: home rehabilitation for frail elderly after acute hospitalisation is a viable option for selected patients and is associated with a lower risk of delirium, greater patient satisfaction, lower cost and more efficient hospital bed use.
Keywords: delirium, health services for the aged, home-care services, hospital based, patient satisfaction, rehabilitation, elderly
Received January 30, 2005; accepted in revised form August 3, 2005.
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