Time-limited intensive home care for elderly patients after discharge

Safe discharge is a type of intensive home care intervention. It is mainly offered to older people who need extra support in conjunction with discharge from the hospital. The intervention includes extra care time for the elderly for a limited period (1 to 2 weeks) by staff in special home reception teams. Safe discharge is a Swedish intervention that has emerged in recent years and is found in around half of the country's municipalities.

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Question

What systematic reviews are there on the effect of intensive home care after discharge from the hospital?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
RCT = Randomised controlled trial
Included studies Population/Intervention Outcome and Results
Sempé et al, 2019, [1]
Study design: 15 studies (5 RCTs, 5 controlled pre-post studies and 3 non-controlled observational studies)

Setting: Studies were from USA (4), England/UK (2), New Zeeland (1) and Singapore (1)

Categories: Studies were categorised to either transitional care (n=8), case management (n=4) or hospital-at-home (n=3)

Risk for bias: Moderate risk for bias
Population: Older people (defined as aged over 60 years old) with multimorbidity or frailty

Intervention: Home-based interventions by any type of multidisciplinary team that aimed at reducing avoidable displacement from home
Effect: The review focused on the results from studies with low risk for bias (n=3).

Readmission rate (30 days):
I: 11.7% vs C: 17.3%; p<0.001

Readmission rate (1–10, 11–30, 31–90 days):
I: 76.8% vs C: 69.2%;p>0.05

Readmission rate (28 days)
Regression discontinuity parameter estimation:
–1.60 (SD 3.10); p=0.05
Authors' conclusion: “…the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home.”
Sims-Gould et al, 2017, [2]
Study design: 15 RCT-studies

Setting: from Denmark (1), Norway (2), England/UK (3), Netherlands (1), Australia (5), New Zeeland (2), USA (1)

Categories: 7 studies focused on rehabilitation, 6 on restorative, 2 studies on reablement, and none on reactivation

Risk for bias: Moderate risk for bias
Population
Community dwelling older adults (65 years+) in receipt of home care services. In total, n=2364 (range 29–750)

Mean age 76–83 years

Intervention
4R programs, i.e., reablement, reactivation, rehabilitation or restorative, delivered in the home over 4–24 weeks. A personalized and tailored approach characterizes the interventions

Comparison
Home care recipients not in receipt of any 4R interventions, but who continued to receive home care services
Functional abilities
Two studies reported no changes in functional abilities over the intervention period and seven studies found improvements that lasted several months to a year. These functional improvements included fewer activity restrictions at 3 months postintervention (1); improved ADL scores and self-assessed ability in the kitchen at 3 months, and in the execution of domestic tasks at 12 months (1); better home management and self-care (1); improvements in ADL and IADL at 6 months (1).

Clinical outcomes
Statistically significant clinical outcomes: improvement in self-reported walking im-pairments (1); improved mobility scores (1); improved physical function (1); overall score and gait speed (1) ; improved Timed-Up and Go (2) and other test scores (1).
Better rates of survival (2).
A higher number of falls both during the intervention and at 6 months’ follow-up among those who received the home care program compared with a center-based falls reduction program (1).

Older adult outcomes
No change in quality of life (1); no change in mental state (1); no statistically significant change in mood, pain, or cognition (1); no change in social support (1). An exception was improvements in mental well-being at both 3 and 6 months postintervention (1).

Care giver outcomes
No significant findings were re-ported with respect to the carers. An improvement in carers’ General Health Ques-tionnaire was found at both 3 and 12 months postintervention (1).

Service usage outcomes
Several interventions appeared to facilitate participants continuing to live at home, rather than transferring to residential care (4).
Reduced home care use at various follow-up points: number of participants requiring ongoing home care at 3 and 12 months (2), length of time receiving home care was shorter overall (1); fewer home care hours and a lower total home care cost over a 9-month period (1) and a 2-year period (1).

Health care resource utilization: cost analyses
Interventions reduced the total number of emergency room visits (2), unplanned hospital stays (1) and total hospital days (2).
Authors' conclusion: “From cost savings to improvements in clinical outcomes, 4R interventions show some promise in the home care context. However, there are several key issues across studies, including questions surrounding the generalizability of the results, in particular with respect to the ineligibility criteria for most interventions; the lack of information provided on the interventions; and lack of in-formation on staff training”.

References

  1. Sempe L, Billings J, Lloyd-Sherlock P. Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review. BMJ Open 2019;9:e030687.
  2. Sims-Gould J, Tong CE, Wallis-Mayer L, Ashe MC. Reablement, Reactivation, Rehabilitation and Restorative Interventions With Older Adults in Receipt of Home Care: A Systematic Review. J Am Med Dir Assoc 2017;18:653-663.
Published: 11/1/2021 Report no: ut202124 Registration no: SBU 2021/368

Literature search

CINAHL via EBSCO 6 September 2021

Title: Time-limited intensive homecare for elderly patients after discharge
The final search result, usually found at the end of the documentation, forms the list of abstracts.

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
Search terms Items found
Population: Elderly
1. (MH "Aged") OR (MH "Aged, 80 and Over") OR (MH "Aged, Hospitalized") OR (MH "Frail Elderly") OR (MH "Geriatrics") OR (MH "Aging") OR TI ("older patient" OR "older patients" OR "older adult" OR "older adults" OR "older person" OR "older persons" OR "older women" OR "older men" OR geriatric OR geriatrics OR elderly OR elders OR elder OR senior OR seniors OR 'community dwelling' OR "nursing home" OR "nursing homes" OR "care home" OR "care homes" OR "oldest old" OR frail OR postmenopaus OR postmenopausal OR 'post menopaus' OR 'post menopausal' OR 'late life' OR 'latest life' OR "old age") 948 339
Intervention: Intensive home care programs after discharge
2. (TI ((intermediate OR transitional) N3 care N3 (discharge OR home))) OR (AB ((intermediate OR transitional) N3 care N3 (discharge OR home))) 257
3. (TI (Hospital-to-home OR inpatient-to-home OR hospital-at-home OR "home-based treatment team")) OR (AB (Hospital-to-home OR inpatient-to-home OR hospital-at-home OR "home-based treatment team")) 2 350
4. (TI (intens* N2 home N5 (rehabilitation OR support* OR care OR treatment)))) OR (AB (intens* N2 home N5 (rehabilitation OR support* OR care OR treatment)))) 208
5. (TI "early supported discharge") OR (AB "early supported discharge") 135
6. (TI (Discharge N3 team*)) OR (AB (Discharge N3 team*)) 299
7. (TI (early OR earlier OR prompt OR accelerate* OR acute OR subacute OR supported ) N5 discharg*) OR (AB (early OR earlier OR prompt OR accelerate* OR acute OR subacute OR supported ) N5 discharg*) 6 197
8. (TI (early OR earlier OR prompt OR accelerate* OR supported) N5 return* N2 home*) OR (AB (early OR earlier OR prompt OR accelerate* OR supported) N5 return* N2 home*) 30
9. (TI (early OR earlier OR acute OR subacute OR post‐discharge) N5 (community OR domiciliary OR "primary care" OR home OR home‐based) N5 (rehabilitation OR support* OR care)) OR (AB (early OR earlier OR acute OR subacute OR post‐discharge) N5 (community OR domiciliary OR "primary care" OR home OR home‐based) N5 (rehabilitation OR support* OR care)) 4 142
10. (TI (post‐discharge OR "home rehabilitation") N5 (support* OR care)) OR (AB (post‐discharge OR "home rehabilitation") N5 (support* OR care)) 653
11. OR/2-12 13 004
Study types: Systematic Reviews
12. PT Reviews OR (MH “Systematic Review” OR MH “Meta Analysis”) OR (TI (Systematic* N3 review*) OR “Meta-analysis”) OR (AB (Systematic* N3 review*) OR “Meta-analysis”) 192 748
Combined sets:
13. 1 AND 11 4 338
Final result
  12 AND 13 118

SocINDEX via EBSCO 6 September 2021

Title: Time-limited intensive homecare for elderly patients after discharge
The final search result, usually found at the end of the documentation, forms the list of abstracts.

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
Search terms Items found
Population: Elderly
1. (DE "OLDER people" OR “AGED care” OR “AGING” OR “GERIATRICS) OR TI ("older patient" OR "older patients" OR "older adult" OR "older adults" OR "older person" OR "older persons" OR "older women" OR "older men" OR geriatric OR geriatrics OR elderly OR elders OR elder OR senior OR seniors OR 'community dwelling' OR "nursing home" OR "nursing homes" OR "care home" OR "care homes" OR "oldest old" OR frail OR postmenopaus OR postmenopausal OR 'post menopaus' OR 'post menopausal' OR 'late life' OR 'latest life' OR "old age") 44 080
Intervention: Intensive home care programs after discharge
2. (TI ((intermediate OR transitional) N3 care N3 (discharge OR home))) OR (AB ((intermediate OR transitional) N3 care N3 (discharge OR home))) 40
3. (TI (Hospital-to-home OR inpatient-to-home OR hospital-at-home OR "home-based treatment team")) OR (AB (Hospital-to-home OR inpatient-to-home OR hospital-at-home OR "home-based treatment team")) 240
4. (TI (intens* N2 home N5 (rehabilitation OR support* OR care OR treatment)))) OR (AB (intens* N2 home N5 (rehabilitation OR support* OR care OR treatment)))) 61
5. (TI "early supported discharge") OR (AB "early supported discharge") 3
6. (TI (Discharge N3 team*)) OR (AB (Discharge N3 team*)) 23
7. (TI (early OR earlier OR prompt OR accelerate* OR acute OR subacute OR supported ) N5 discharg*) OR (AB (early OR earlier OR prompt OR accelerate* OR acute OR subacute OR supported ) N5 discharg*) 351
8. (TI (early OR earlier OR prompt OR accelerate* OR supported) N5 return* N2 home*) OR (AB (early OR earlier OR prompt OR accelerate* OR supported) N5 return* N2 home*) 19
9. (TI (early OR earlier OR acute OR subacute OR post‐discharge) N5 (community OR domiciliary OR "primary care" OR home OR home‐based) N5 (rehabilitation OR support* OR care)) OR (AB (early OR earlier OR acute OR subacute OR post‐discharge) N5 (community OR domiciliary OR "primary care" OR home OR home‐based) N5 (rehabilitation OR support* OR care)) 402
10. (TI (post‐discharge OR "home rehabilitation") N5 (support* OR care)) OR (AB (post‐discharge OR "home rehabilitation") N5 (support* OR care)) 46
11. OR/2-10 13 004
Study types: Systematic Reviews
12. PT Reviews OR (TI (Systematic* N3 review*) OR “Meta-analysis”) OR (AB (Systematic* N3 review*) OR “Meta-analysis”) 8 950
Combined sets:
13. 1 AND 11 1 085
Final result
  12 AND 13 7

Embase via Embase.com 3 September 2021

Title: Time-limited intensive homecare for elderly patients after discharge
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search terms Items found
Population: Elderly
1. 'aged'/de OR 'aged hospital patient'/de OR 'frail elderly'/de OR 'very elderly'/de OR 'geriatric patient'/de OR 'elderly care'/exp OR "older patient":ti OR "older patients":ti OR "older adult":ti OR "older adults":ti OR "older person":ti OR "older persons":ti OR "older women":ti OR "older men":ti OR geriatric:ti OR geriatrics:ti OR elderly:ti OR elders:ti OR elder:ti OR senior:ti OR seniors:ti OR 'community dwelling':ti OR "nursing home":ti OR "nursing homes":ti OR "care home":ti OR "care homes":ti OR "oldest old":ti OR frail:ti OR postmenopaus:ti OR postmenopausal:ti OR 'post menopaus':ti OR 'post menopausal':ti OR 'late life':ti OR 'latest life':ti OR "old age":ti OR (older NEAR/2 people):ti 3 467 934
Intervention: Intensive home care programs after discharge
2. ((intermediate OR transitional) NEAR/3 care NEAR/3 (discharge OR home)):ti,ab,kw 275
3. (“Hospital-to-home” OR “inpatient-to-home” OR “hospital-at-home” OR “home-based treatment team”):ti,ab,kw 2 274
4. (intens* NEAR/2 home NEAR/5 (rehabilitation or support$ OR care OR treatment)):ti,ab,kw 733
5. ((“Crisis resolution” OR “home treatment” OR “home-based treatment”) NEAR/3 team*):ti,ab,kw 235
6. (Discharge NEAR/3 team$):ti,ab,kw 645
7. ((early or earlier or prompt or accelerate$ or acute or subacute or supported) NEAR/5 discharg$):ti,ab,kw 16 500
8. ((early or earlier or prompt or accelerate$ or supported) NEAR/5 return$ NEAR/2 home$):ti,ab,kw 83
9. ((early or earlier or acute or subacute or post‐discharge) NEAR/5 (community or domiciliary or “primary care” or home or home‐based) NEAR/5 (rehabilitation or support$ or care)):ti,ab,kw 7 177
10. ((post‐discharge or “home rehabilitation”) NEAR/5 (support$ or care)):ti,ab,kw 192
11. OR/2-10 26 728
Study types: Systematic Reviews
12. ‘Systematic review’/exp OR ‘meta-analysis’/exp OR ((Systematic* NEAR/3 review*) OR ‘Meta-analysis’):ti,ab,kw 527 518
Combined sets
13. 1 AND 11 7 184
Final result
  12 AND 13 130
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