Acute Hospital Care at Home for Dementia

Overseen By David M Levine, MD, MPH, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Brigham and Women's Hospital

Must not be taking: Methadone

Disqualifiers: End-stage renal disease, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 1 year

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to compare hospital care at home with traditional hospital care for individuals with moderate to severe dementia. Researchers seek to determine if treating serious health issues at home is as effective and safe as hospital treatment. Participants will receive either standard hospital care or a home-based hospital care service, known as Acute Hospital Care at Home, which includes home visits and on-demand evaluations. The trial seeks individuals with dementia who have been hospitalized at least once in the past year and live near a family caregiver. As an unphased trial, this study offers participants the chance to contribute to innovative care solutions that could enhance the quality of life for those with dementia.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this acute hospital care at home intervention is safe for people living with dementia?

Research has shown that receiving hospital-level care at home is generally safe for patients. One study found that 30 days after leaving home care, 3.2% of patients had passed away, 2.6% required skilled nursing facilities, and 15.6% were readmitted to a hospital. These outcomes are similar to those of patients who stayed in a traditional hospital, suggesting that home care is well-tolerated and does not lead to more serious health issues compared to regular hospital stays.

While researchers continue to study this type of care, these findings offer reassurance about its safety for people with dementia. Always consult a healthcare provider for more personalized information. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Acute Hospital Care at Home for dementia because it offers a unique approach to treating acute illnesses by bringing hospital-level care directly to the patient's home. Unlike the traditional method of acute care, which requires hospitalization in a physical facility, this treatment involves home visits for serious illness conversations and on-demand evaluations. This approach aims to provide a more comfortable and familiar setting for patients, potentially reducing stress and disorientation commonly experienced by dementia patients in hospital environments. By maintaining the patient's routine and surroundings, this method could enhance overall well-being and improve outcomes for those with dementia.

What evidence suggests that acute hospital care at home is effective for dementia?

Research has shown that people with dementia often stay in the hospital longer than those without memory problems. This trial tests "Acute Hospital Care at Home" as an innovative approach to deliver hospital-level care in a patient's home. The approach aims to reduce the stress and disruption that traditional hospital stays can cause for dementia patients. While specific data on its effectiveness for dementia is limited, similar home care models have demonstrated positive results in improving satisfaction for patients and caregivers. These models have also been associated with better health system efficiency and patient outcomes in other contexts. ^{2 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for people with dementia who need acute hospital care. They must have a family caregiver willing to enroll and provide consent, as the patient may only be able to assent. There's no specific mention of exclusion criteria provided.

Inclusion Criteria

Resides in a private or assisted living residence with or nearby (<15min travel time) to a family caregiver

Diagnosis of moderate or severe dementia as ascertained by the Quick Dementia Rating System (QDRS)

Resides within the MGB home hospital catchment area

Exclusion Criteria

Resides in a group home

I am on dialysis for end-stage kidney failure.

No functioning utilities such as no working heat (October-April), no running water, or no electricity

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive acute hospital care at home or usual care in a hospital setting

1 year

Home visits as needed for acute care

Follow-up

Participants are monitored for safety and effectiveness after treatment

30 days

What Are the Treatments Tested in This Trial?

Interventions

• Acute Hospital Care at Home

Trial Overview The study compares providing acute hospital-level care at home versus usual hospital care for dementia patients. Participants are randomly placed into either the home care group or standard treatment group, based on their ability to perform daily activities.

How Is the Trial Designed?

Group I: Acute hospital care at home Experimental Treatment 1 Intervention

Home visit for a serious illness conversation. Acute illness evaluation on demand. Acute hospital care at home as needed.

Group II: Usual care Active Control 1 Intervention

Acute care at a brick-and-mortar hospital.

Who Is Running the Clinical Trial?

Brigham and Women's Hospital

Lead Sponsor

Trials

1,694

Recruited

14,790,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

Hospital-acquired complications like urinary tract infections, pressure areas, pneumonia, and delirium account for 6.4% of total hospital costs for patients over 50, with dementia patients experiencing these complications at a significantly higher rate (RR 2.5).

These complications lead to an eightfold increase in hospital length of stay and double the average episode cost, highlighting the need for improved care models to prevent such issues, especially in dementia patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. Bail, K., Goss, J., Draper, B., et al.[2022]

In a study of 710 older patients (aged over 70) admitted to a hospital, 8.6% experienced reported adverse events (RAEs), with patient-related incidents linked to factors like male gender, delirium, and cognitive impairment.

Despite the high incidence of RAEs, which occurred at a rate of 2.1 per person year, these events were not associated with increased mortality during the hospital stay, as 11.1% of patients died regardless of RAE occurrence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective cohort study of adverse events in older people admitted to the acute general hospital: risk factors and the impact of dementia. Watkin, L., Blanchard, MR., Tookman, A., et al.[2021]

The study highlights that ensuring patient safety for individuals with advanced dementia in hospitals involves a collaborative approach among staff, emphasizing leadership, teamwork, and transparency to effectively manage risks.

Incorporating the voices of patients and their families is crucial for creating a safe care environment, suggesting that safety practices should be adaptable and responsive to the complexities of everyday clinical situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography. Dadich, A., Rodrigues, J., De Bellis, A., et al.[2023]

Patients with dementia (n = 240) experienced significantly more adverse events during hospitalization, including falls, delirium, and incontinence, compared to those without dementia.

While patients with dementia received more allied health therapies like speech and physiotherapy, they did not show significant functional improvement, highlighting the need for tailored care models to address their unique health care needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization. Fox, A., MacAndrew, M., Wyles, K., et al.[2021]

In a pilot study involving 47 participants aged 60 and over with dementia, person-centered care (PCC) significantly improved behavioral and neuropsychiatric symptoms and care quality compared to usual care after 4-5 days.

Sustained improvements in care quality were observed for patients with longer hospital stays, indicating that PCC can be beneficial for enhancing the overall care experience for individuals with dementia in acute hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. Chenoweth, L., Williams, A., Fry, M., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5785326/

Health Services Utilization in Older Adults with Dementia ... From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0197457221000859

A systematic review of interventions to improve acute ... An analysis of 19269 hospital admissions indicated that people with dementia have significantly longer hospital stays than patients without cognitive impairment ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06819852

Acute Hospital Care at Home for People Living With ... It identifies the role of the intervention that participants receive. Types of arms include experimental arm, active comparator arm, placebo comparator arm, ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2820840

Clinical Outcomes and Cost-Effectiveness of Collaborative ... The findings suggest that CDCM is associated with improved patient, caregiver, and health system–relevant outcomes over 36 months.

5. mass.gov mass.gov/doc/a-social-medical-model-for-dementia-care-august-2025/download

A Social-Medical Model for Dementia Care Through rigorous data collection including ongoing stakeholder feedback, the healthcare system will continuously document learnings and outcome data; analyze ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10872234/

Acute Hospital Care at Home in The United States At 30-days post-discharge, mortality was 3.2%, skilled nursing facility use was 2.6%, and readmission was 15.6%. These outcomes were similar in ...

7. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0218426

Impact of health service interventions on acute hospital use in ... No health service intervention beyond usual care was found to reduce acute hospital use in community-dwelling persons with dementia.

8. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0293-3

Acute hospital dementia care: results from a national audit The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland.