Previous in-home physiotherapy prevents institutionalization after short-term hospitalization in community-dwelling older dependent people.

AIMS: Short-term hospitalization of community-dwelling older dependent people in a geriatric acute care unit is sometimes needed to treat an acute health problem. Serious loss of independence can lead to difficulties in maintaining home care and is followed, at hospital discharge, to institutionalization in a long-term care home. We investigated the variables, particularly those related to the paramedical staff at home, predicting a return home or an institutionalization at hospital discharge. METHODS: Retrospective observational study of 398 sixty and more year-old patients, living at home, having a natural caregiver, and hospitalized in an acute care unit of the State Geriatric Center. RESULTS: 289 (72.6%) patients returned home, 101 (25.3%) were admitted in a long-term care home, and 8 (2%) died. Independent predictors of institutionalization were length of stay in the acute care unit [adjusted OR (AOR) = 1.102, P < 0.001], disruptive behavioral and psychological symptoms of dementia (BPSD, AOR = 1.827, P = 0.039), caregiver burden (AOR = 1.976, P = 0.038), moderately severe-to-severe cognitive impairment (AOR = 2.121, P = 0.011), and living alone with a close or a remote caregiver (AOR = 2.620 and 4.446, P = 0.003 and 0.001, respectively). In-home physiotherapy was independently associated (AOR = 0.393, P = 0.002) with a lower risk of institutionalization. CONCLUSION: In-home physiotherapy should be recommended to community-dwelling older dependent people, especially if they are living alone and/or if they present disruptive BPSD and/or moderately severe-to-severe cognitive impairment.

Supraglottitis: the need of a standardized protocol.

Supraglottitis is an acute airway emergency requiring prompt medical intervention. Ten cases of epiglottitis treated at San Pablo Hospital are reviewed retrospectively. The controversies regarding this diagnosis are discussed. Due to a wide range of opinions concerning the proper management and treatment of epiglottitis, and the need of a standardized protocol, a simple and flexible protocol to be used by all physicians is proposed.