MBBS (Sydney) MD (NSW) FRACP
Associate Professor Caplan is Director of Post Acute Care Services and Director of Geriatric Medicine at Prince of Wales Hospital and a Conjoint Associate Professor at the University of New South Wales in Sydney, Australia.
His research involves
developing and rigorously testing new health services, he has been a chief investigator on 5 investigator-initiated RCTs, and
the pathophysiology of delirium, where he works with a consortium of international investigators.
He led the Prince of Wales involvement as lead hospital in three phases of the National Demonstration Hospitals Program (NDHP) and has served as a consultant to Commonwealth and State Health Departments including the Australian Health Ministers Advisory Council.
The SCOOP on Secondary Care Out to Older People
Gideon A Caplan
Secondary Geriatric Medicine care in the community includes acute care, subacute or post acute care after hospitalisation, and chronic care, which is sometimes called pre-acute care.
Acute and subacute/post acute care is provided as a substitute for care in hospital and is also known as Hospital in the Home (HITH). Patients are referred from general practitioners, emergency departments or hospital wards. This care is provided by multi-disciplinary teams, including nursing, medical and allied health staff. HITH teams may focus on one disease or organ system, but are usually general, but treat a predominance of older patients, and the evidence suggests that frail older people benefit more, because of their higher risk of hospital-associated complications. Patients are treated in their usual residence, including residential aged care facilities.
Meta-analysis of HITH shows that treating people at home reduces mortality by 19%, readmissions by 25% and costs by 26%. Patient satisfaction is increased in HITH.
Chronic care or geriatric preventative home visiting is aimed at maintenance, preventing health and functional decline and subsequent hospital or nursing home admission. Patients are referred from general practitioners or community services. The studies that have been done include single or multiple home visits with structured comprehensive geriatric assessments performed by a variety of health care workers including geriatricians, and were conducted in Australia, Europe and the US. Overall there have been more than 20 randomised controlled trials including more than 60,000 subjects.
Meta-analyses of these trials show no significant effect on mortality, functional status decline, hospital or nursing home admission. However subgroup analysis found a 26% reduction in mortality in younger patients, those ≤77 years. There was no difference found based on the professional group of the person doing the visit.
In conclusion, the data clearly shows that greater involvement in HITH is worthwhile, whereas there is insufficient evidence to support Geriatric home visits.
Call for Abstracts open: 25th October 2016
Registration Opens: 18th November 2016
Call for Abstracts Closes: 24th February 2017
Notification of Abstracts: 20th March 2017
Close of Early Registration: 31st March 2017
Conference: 10th May 2017
Australian and New Zealand Society for Geriatric Medicine (ANZSGM)
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