title: 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.
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil. marlon.aliberti@hc.fm.usp.br.
authors.forename: Márlon J R
authors.initials: MJ
authors.lastname: Aliberti
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Suemoto
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Sileno Q
authors.initials: SQ
authors.lastname: Fortes-Filho
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Melo
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Carolina B
authors.initials: CB
authors.lastname: Trindade
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Juliana Y T
authors.initials: JY
authors.lastname: Kasai
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Altona
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Apolinario
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Jacob-Filho
mesh_terms: D000368:Aged; D001938:Brazil; D003631:Day Care, Medical / Q000379:methods / Q000458:organization & administration; D018450:Disease Progression; D017598:Efficiency, Organizational; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006297:Health Services Accessibility / Q000458:organization & administration; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D012017:Referral and Consultation / Q000458:organization & administration; D020379:Risk Adjustment / Q000379:methods / Q000458:organization & administration
keywords: aged; day hospital; geriatrics; health services; hospitalization