Hospitalization at home, a good option for the Elderly

Traditionally, when we think of an elderly person with an acute illness, we put the patient in a hospital scenario receiving care until their illness is compensated. 

Throughout history, patient care at home has undergone multiple changes. From 1930, where approximately 40% of care was provided by a family doctor in the patient's home, until the early 5s, where home care did not even represent XNUMX% of the patients treated.

In 1947, at the Guido Montefiore University Hospital in New York, the possibility of home management was offered with the purpose of decongesting the hospital, finding a more favorable psychological climate for the patient and treating the needs due to the absence of health insurance. In 1951, the Tenon Hospital in Paris was the first to create a home hospitalization unit. By the XNUMXs, home hospitalization services were formed in latitudes such as Canada, the United Kingdom, Germany, Sweden and Italy, aimed at surgical patients with a focus on early discharge.

The Boom in home hospitalization in times of the COVID19 Pandemic puts this modality of clinical care on the stage since at that time the isolation restrictions in hospitals, the fear of contagion, the fear of dying alone and the high costs in the private sphere create this new area of ​​opportunity; patients and families once again preferring a home environment to overcome their disease processes. 

In frail older people, the hospital environment can have a negative impact with an increase in the probability of events such as: delirium (altered alertness), iatrogenic injuries, functional deterioration, nosocomial infections, increased mortality and risk of hospital readmission. . Therefore, the elderly benefit from short hospitalizations where the patient can be compensated with subsequent home monitoring.

Hospitalization at home gives the patient and their family the opportunity to overcome the acute event in their environment, surrounded by their loved ones, with less fear of a stricter environment such as the hospital and, above all, with fewer adverse events associated with the environment. nosocomial.

This health care model has the peculiarity of being Multidisciplinary (shared care model), where care is provided under the direction of a General Physician (Geriatrician in the case of older people) with constant communication with the nursing, physiotherapy, nutrition, respiratory therapy or a specialist from another discipline in co-management for the benefit of the patient; all this without requiring a hospital infrastructure and the costs associated with it.

Currently, highly complex patients can be managed through technological tools such as applications, monitoring systems and remote reporting, giving the Geriatrician the opportunity to visualize the patient's evolution and the possibility of giving orders to the nursing staff in charge to the dynamic management of the elderly person hospitalized at home. All of this in the patient's environment, surrounded by her loved ones, with the aim of educating the patient and her caregiver in the disease process, thus reducing the burden of emotional impact that is naturally present in delicate situations.

If you are an elderly person or have elderly relatives, it is important to discuss these topics, even if they are not going through a disease process that requires hospital management. It is important to talk to your primary care physicians about what to do or not do in emergency situations and whether or not home management is preferred over that offered in a hospital. Respecting the will of the human being is an act of love and respect.