Introduction. This study was performed to evaluate if an early discharge to a Hospital at Home Service (HHS) produced differences in all cause mortality (combined endpoint) and hospital readmissions in elderly patients affected by severe heart failure.Methods. From September 1st 2008 to May 31st 2010, patients 65 years or older admitted to the Emergency Department of the San Giovanni Battista Hospital of Turin for acute decompensated CHF were selected. Patients were randomly assigned to two groups: 26 hospitalized in general wards where they received routine hospital care (group 1), 26 hospitalized and early discharged to the Hospital at Home Service- HHS (within 120 hours) (group 2).Results. Patients were very old (mean age 81 years), comorbid, 73% had severe symptoms of heart failure (NYHA IV), without differences between the two groups. No differences in mortality and hospital readmission rates were found. Mood level improved in HHS patients only.Discussion. This is a pilot study on early discharge for elderly patients with advanced heart failure. Home care should be considered as an important element toward adjusting the transition in frail hospitalized patients effectively.

Introduction. The aim of the study was to evaluate the main features of patients 65 years of age or older admitted to the Emergency Department (ED) for a fall and analyze consequences of falls, new falling events and related predicting factors, hospital recovery rate and institutionalization at 1 month follow-up.Methods. From February 1st to April 30th 2011, 100 patients 65 years of age or older admitted to the ED of the San Giovanni Battista Hospital of Turin for a fall were selected. In the ED a baseline multidimensional assessment was performed. On discharge, we evaluated: allocation, complications, length of hospital stay and diagnosis. At one-month follow-up new falling events, mortality, hospital readmission rate and institutionalization were evaluated.Results. The enrolled patients were very old (mean age 82.5 years), comorbid and in polipharmacy. Twenty four percent of the falls produced traumas, 51% required hospitalization. At 1-month follow-up, 85 patients lived at home, 13 were institutionalized and 2 died. Recurrent falls occurred in 12% of the subjects.Discussion. Patients who access the ED for a fall are often very old and frail. Falls are frequently responsible for traumas and fractures which can determine longer hospitalization or institutionalization. There is need to introduce prevention strategies in order to reduce the incidence of the events and improve quality of life in the elderly with previous falls.

Introduction. The objective of the study was to evaluate the epidemiology of pressure ulcers and the characteristics of an elderly population with pressure sores admitted to the Hospital at Home Service (HHS) of the San Giovanni Battista Hospital (Torino, Italy). Methods. A descriptive study was conducted on patients admitted to the HHS from January 1st to June 30th 2010, referred from the Emergency Department or other hospital wards. Results. Data of 36 patients with pressure sores were analyzed: 34 patients presented an ulcer upon admission and 2 patients developed pressure ulcers during hospitalization. Patients were very old (mean age 85 years), comorbid, functionally impaired. 50% of patients had stage I ulcers, 28% stage II, 22% stage III-IV; 50% of patients had more than one pressure sore. Most patients were discharged to their home (61%), with programmed health care services in about 17% of cases; mortality rate was 30.5%. Discussion. In our study prevalence rates (about 13%) agree with international data; incidence (0.6%) was lower than data from hospital wards. A possible explanation could be that patients who are at home continue to be followed not only by a multidisciplinary team, but can also rely on the presence of a costant caregiver, who if appropriately educated by the geriatric team, can provide specific and ongoing care.

Introduction. The aim of this study was to evaluate the feasibility of the Step Training System (STS, an exergame appropriate for training) in old frail patients undergoing rehabilitation. In particular, we focused our attention on factors, such as physical and cognitive functions, which could interfere with an appropriate use of this technology; moreover, we assessed the degree of enjoyment and satisfaction experienced by patients during the training period.Methods. From 1st October 2009 through 31st January 2010, we enrolled 44 elderly patients admitted to the Geriatric Rehabilitation ward of the Prince of Wales Hospital of Sydney. All patients have practiced the STS daily with different speed levels, based on patient's capabilities. At the end of the study period, patients were divided into two groups: poor performers, which have been unable to improve speed velocity over basal speed at the STS, and good performers, including those patients that improved their performances over time.Results. The mean age of the patients was 82.8 years, the mean number of comorbidities was 6.3 per patient, and all patients showed mild cognitive and functional impairment. Fifty two percent of patients reported at least one fall in the previous year. By comparing the 2 groups, good performer patients were more likely to live alone (p = 0.046) and to have an higher score at the cognitive tests. Patients' satisfaction was very high (97% of the patients reported a good-great experience).Discussion. Taking together the results of the present pilot-study demonstrate the utility of the STS in old patients undergoing rehabilitation.

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.