The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization

Abstract

Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6-hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self-reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost-effectiveness.

Prognostic value of a rapid sarcopenia measure in acutely ill older adults

“…The primary reasons for referral include infectious diseases, acute anemia, uncontrolled hypertension, decompensated diabetes, symptomatic congestive heart failure, investigation or treatment of refractory pain, electrolyte disorders, and severe behavioral symptoms in dementia. Further details about the day hospital can be found in previous research [19].…”

Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department

“…falls and syncope unit, bone health clinic, memory clinic, general geriatric outpatient clinic), with a typical waiting time of weeks to months; and • Discharge to the Geriatric Day Hospital. In Ireland and other countries [12], this has evolved to an 'Ambulatory Care Hub' model with access to outpatient diagnostics/therapy staff enabling 'rapid access' CGA and ongoing therapy to support and facilitate ED admission avoidance and hospital Early Supported Discharge schemes. [13] , [14] The typical wait for this is days to weeks.…”

Targeted Geriatric Assessment for Fast‐Paced Healthcare Settings: Development, Validity, and Reliability

“…The primary reasons for referral included infection, acute anemia, symptomatic congestive heart failure, decompensated diabetes, and uncontrolled hypertension. Further details about the GDH can be found elsewhere . Six hundred and one older people were referred to the GDH during the study period.…”