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New evidence suggests that alternatives to acute hospital admissions for older people are safe and can reduce hospital use

31 August 2017

Research published in BMJ Open has found that alternatives to acute hospital admissions for older people appear safe and could reduce both the number and duration of acute hospital stays.

The study, funded by the National Health Institute for Research and led by Professor Sarah Purdy at the University of Bristol's Centre for Academic Primary Care, identified and appraised alternatives to acute hospital care for people over the age of 65.

The systematic review looked at 19 randomised and non-randomised controlled studies and seven previous reviews. The studies included patients with specific conditions such as heart failure or chronic obstructive pulmonary disease, as well as mixed chronic and acute conditions such as elderly frail patients with pneumonia.

The study identified four main types of acute hospital alternatives for patients:

· paramedic intervention

· intervention in A&E departments

· care in a community hospital

· ‘hospital-at home’ services

The evidence suggests that these alternatives to hospital admission appear safe with potential to reduce acute hospital care use and length of time patients need to receive care. For example, older patients with heart failure treated through a 'hospital-at-home' service saw the time period between hospital admissions increase significantly – without any increased risk in mortality - compared to similar patients who were routinely admitted.

Further information

Paper: 'A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission': Alyson L Huntley, Melanie Chalder, Ali R G Shaw, William Hollingworth, Chris Metcalfe, Jonathan Richard Benger, Sarah Purdy. Published in BMJ Open.

About the Centre for Academic Primary Care, University of Bristol
The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. See also information on avoidable hospital admissions research at CAPC.

About the NIHR
The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health, the NIHR:

  • funds high quality research to improve health
  • trains and supports health researchers
  • provides world-class research facilities
  • works with the life sciences industry and charities to benefit all
  • involves patients and the public at every step

For further information, visit the NIHR website

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