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

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The investigators will perform a parallel-group multicenter randomized controlled trial of a 1-year pre-enrolled acute hospital care at home intervention vs usual care for people living with dementia. Patients will be randomized only after eligibility determination and after the family caregiver agrees to enroll; people living with dementia will assent when able. Patients will be allocated in a concealed fashion to the control and intervention groups in randomly selected block sizes of 4 or 6 in 4 strata reflecting their functional status (activities of daily living: 0, 1, 2-3, 4-6). Although family and clinicians cannot be blinded, the investigators will blind the data collectors and assessors.

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.

Is Acute Hospital Care at Home safe for people with dementia?

Research shows that people with dementia in hospitals often face more complications like falls, infections, and medication errors compared to those without dementia. This suggests that special care is needed to ensure safety for dementia patients in hospital settings. ^{1 2 3 4 5}

How is the Acute Hospital Care at Home treatment for dementia different from other treatments?

Acute Hospital Care at Home for dementia is unique because it provides hospital-level care in the comfort of a patient's home, which can reduce the emotional strain and complications often associated with hospital stays for dementia patients. This approach aims to minimize the need for hospital visits, which are typically challenging for individuals with dementia. ^{6 7 8 9 10}

What data supports the effectiveness of the treatment Acute Hospital Care at Home for Dementia?

The research highlights that people with dementia often face challenges in hospital settings, such as inappropriate care and longer stays, which can lead to poorer outcomes. While specific data on 'Acute Hospital Care at Home' is not provided, the general emphasis on improving care for dementia patients suggests that alternative care models, like home-based care, could potentially reduce hospital use and improve patient outcomes. ^{7 9 11 12 13}

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

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]

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]

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]

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]

Citations

1. Germany pubmed.ncbi.nlm.nih.gov

[Dementia--a secondary diagnosis in acute hospital care or more? Measures for improving care of hospitalized dementia patients]. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Impact of health service interventions on acute hospital use in community-dwelling persons with dementia: A systematic literature review and meta-analysis. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Retrospective study of more than 5 million emergency admissions to hospitals in England: Epidemiology and outcomes for people with dementia. [2023]

4. England pubmed.ncbi.nlm.nih.gov

The effectiveness of interventions to improve the care and management of people with dementia in general hospitals: A systematic review. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. [2022]

6. England 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. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography. [2023]

8. England pubmed.ncbi.nlm.nih.gov

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. [2022]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Factors Associated with Length of Stay in Hospital Patients with and Without Dementia. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization. [2021]

11. Germany pubmed.ncbi.nlm.nih.gov

[Impact of dementia on length of stay and costs in acute care hospitals]. [2018]

12. United States pubmed.ncbi.nlm.nih.gov

Dementia care in acute hospitals: A framework for practice development and theory-based evaluation. [2023]

13. Germany pubmed.ncbi.nlm.nih.gov

["Memory acute"-treatment concept for inpatient remobilization of acutely ill patients with dementia]. [2020]