Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, particularly for patients with serious conditions. The Hospital at Home Service (HHS) of Torino is a multidisciplinary, physician-led unit, established in 1985. About 15% of HHS patients have Acute Heart Failure (AHF), requiring on occasion intravenous diuretics and dopamine. A Randomized Controlled Trial of telemonitoring, was initiated in 2014 for patients with AHF receiving home management as an alternative to hospital care. Through the web-platform “Nuvola IT HomeDoctor”, physicians and nurses remotely monitor vital signs (blood pressure, heart rate, oximetry, weight), treating accordingly. The technology is simple, and well accepted by patients and caregivers. We will present an overview of our model of care, and the impact of telemonitoring upon frequency of home visits by HHS staff, and quality of life of patients and caregivers.

Objectives. Several challenges are posed to the healthcare sector in terms of using innovative tools and technologies. They include a growing ageing population, an epidemic of citizens in chronic conditions, and further development in medical progress which offers new and better treatments. The main goal of this study is to evaluate how telemedicine could be helpful for the home treatment of acutely decompensated chronic heart failure patients or for patients affected by chronic obstructive pulmonary disease (COPD). Methods. Telemonitoring devices have been tested on an elderly population affected by acute heart failure or chronic obstructive pulmonary disease. Results. Eighteen patients have been involved in the study, with a mean age of 86,07 years. They were functional and cognitively impaired. We have collected 772 tele-relevations with only 3 technical problems. Conclusions. Tele-homecare and telemedicine could be useful in different settings and situations: in rural context and in big cities. Our preliminary results demonstrate that telemonitoring elderly patients is feasible. Randomized controlled trials (RCT) are required to evaluate the impact of these new technologies.

A home hospitalization service (NHS) has been operating in our hospital of Turin since 1985. HHS allows to perform diagnostic and therapeutic interventions, which are usually made in hospital, also at home. The objectives of the study were: to assess the feasibility of HHS for elderly patients with advanced dementia and a relevant degree of comorbidity, to identify benefits of this care setting, compared with general medical care in reduction of the caregiver's stress and the requirement for long-term institutional care. The study was conducted on 82 patients with advanced dementia: 41 were managed at home by HHS and 41 in a general medical ward (GMW). Both groups were examined using the same protocol and were evaluated at admission and discharge. No significant differences between the two groups were observed at admission for the characteristics and the level of caregivers' stress. Mortality was not significantly different in the two groups. At discharge the use of antipsychotic drugs was significantly reduced in the HHS patients. Only one patient of HHS group was transferred in nursing home versus seventeen of GMW group. The caregivers' stress at discharge was significantly reduced only in the caregivers of HHS patients. In conclusion, HHS is a feasible care alternative to hospitalization of patients with advanced dementia and reduces the requirement for long-term institutional care.

The effectiveness of reality orientation therapy (ROT) carried on over a period of 24 weeks was evaluated. Thirteen institutionalized elderly subjects with cognitive disturbances (Mini Mental State score between 18 and 25) took part in the study; 6 subjects formed the control group. The assessment instruments were the Clifton Assessment Schedule and the Multidimensional Observation Scale for Elderly Subjects. Results suggest that reality orientation techniques can positively interfere with the cognitive performance and the improvement is correlated with the patient's social feeling.