RPD213 - Post-Acute, Home-Based Care Using a Palliative Approach for Dependent Older Adults

Key Message : This study tested a post-acute, home-based palliative care intervention for functionally dependent older adults. It enabled safe discharge, improved function, resolved delirium, and supported hospice transitions, demonstrating feasibility and suggesting that such community-based models can enhance care continuity for medically complex patients.

Abstract:

Background:
Hospitalized patients with complex medical needs and dependence in basic activities of daily living (BADLs) are at increased risk of mortality and further decline, especially when safe discharge is not feasible. This results in prolonged admissions and greater demands on the healthcare system, making them appropriate candidates for home-based interventions using a palliative care approach integrating medical management, functional support, and care coordination.

Objective:
To evaluate outcomes of a multidisciplinary home-based intervention using a palliative care approach for functionally dependent older adults identified by internal medicine wards as difficult to discharge.

Methods:
Hospitalized patients aged ≥65, dependent on BADLs, with a caregiver were eligible regardless of diagnosis. The multidisciplinary team included physicians, nurses, therapists, social workers, and dietitians. Services included medical management, functional rehabilitation, wound care, delirium management, and goal-concordant care planning. Outcomes included functional status (Functional Independence Measure [FIM]), delirium, pressure injury healing, hospice transitions, and use of acute hospital-at-home care.

Results:
Of 326 patients who consented, 312 (95.7%) initiated the intervention; 270 (86.5%) completed three months, and 39 (14.4%) continued for six months. Average FIM increased from 62.4 to 69.5 (Δ +7.1), with 76.0% improving, 11.0% stable, and 13.0% declining. Delirium was present in 32 patients (10.3%) at enrollment and resolved in all, median resolution two weeks. Of 39 patients (12.5%) with pressure injuries, 34 (87.2%) healed. Acute hospital-at-home care was provided to 21 patients (6.7%) for a median of five days. Following the intervention, 33 patients (10.6%) transitioned to hospice in alignment with their goals.

Conclusions:
This post-acute, home-based intervention using a palliative care approach enabled safe discharge for highly complex older adults, improving function and symptoms while facilitating timely hospice transitions. Further research should assess impacts on readmissions and costs.

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