Effect of hospital in the home treatment on physical and cognitive function: a randomized controlled trial.

BACKGROUND Hospitalization for acute illness is associated with higher rates of mortality and morbidity, as well as functional decline, for older patients. We have previously shown that treatment in Hospital in the Home (HITH) results in less confusion and fewer bowel and bladder problems for these patients. However, it is not clear what impact HITH has on physical and cognitive function. METHODS One hundred patients (mean age 70) presenting to the emergency department and assessed by a senior doctor to require admission were randomized to be treated in hospital or at home. We measured the Barthel index, Instrumental Activities of Daily Living (IADL) index, and Mental Status Questionnaire (MSQ) on admission and at discharge. RESULTS The HITH-treated group improved in the IADL and MSQ indices, whereas the hospital-treated group improved only in the MSQ. The improvement in IADL scores remained significant after adjusting for age, sex, living arrangements, development of confusion, and length of stay. CONCLUSIONS HITH offers a safe option for treatment of older patients with a functional advantage over in-hospital care.