ABSTRACT
With advances in monitoring and telemedicine, the complexity of care administered in the home to properly selected patients can approach that delivered in the hospital. The challenges include making sure that qualified personnel regularly visit the patient at home, both individually and in teams; information is accurately communicated among the caregiver teams across venues and over time; and patients understand the information communicated to them by providers. Despite these challenges, the benefits of treating chronically or terminally ill patients at home are significant. Among the most important are improved patient satisfaction and reduced cost. Numerous studies have shown that most patients prefer to spend their convalescence or their last days at home. The financial benefits of enabling patients to recover or to die at home are significant.
Subject(s)
Acute Disease/rehabilitation , Chronic Disease/therapy , Home Care Services/organization & administration , Patient Satisfaction , Telemedicine/trends , Activities of Daily Living , Acute Disease/economics , Chronic Disease/rehabilitation , Comorbidity , Cost Control/methods , Critical Care/economics , Critical Care/methods , Critical Care/trends , Home Care Services/economics , Home Care Services/trends , Humans , Medicare/economics , Medicare/standards , Medicare/trends , Models, Organizational , Monitoring, Ambulatory/economics , Monitoring, Ambulatory/methods , Monitoring, Ambulatory/trends , Palliative Care/economics , Palliative Care/methods , Palliative Care/trends , Telemedicine/economics , Telemedicine/standards , Terminally Ill , United States , VirginiaABSTRACT
Left ventricular assist devices (LVADs) are approved as "destination therapy" (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long-term mechanical support using an older adult case history. Current data on LVAD use in older adults is reviewed, and a discussion of relevant points to consider before LVAD implantation in older adults, including advance care planning, assessment of gait and cognition, and the potential for substantial caregiver burden, is undertaken.
