Retrospective Comparison of Urinary Tract Infection Outcomes in Older Adults: Hospital at Home versus Acute Hospital Admission

Introduction: Hospital admission exposes older adults to harms, including delirium, acute kidney injury (AKI), and mortality. Hospital at Home (HAH) services allow treatment of acute illnesses, such as infection with IV antibiotics in the home setting.

Methods: We retrospectively compared patients managed in the community under HAH with those admitted to an acute frailty ward. Over a twelve-month period, we identified older adults with urinary tract infection requiring IV antibiotics. HAH patients received daily IV ceftriaxone, while inpatients were treated according to hospital guidelines and urine culture results. We compared length of stay, development of delirium and AKI, mortality rate, and readmission rate between the two groups.

Results: During the study period, 38 HAH patients had a mean age of 84 years with an average clinical frailty score of 6 and 24 hospital inpatients had a mean age of 84 years with an average frailty score of 5. The average length of stay was 3.3 days for patients treated under HAH versus 21.3 days in hospital. Only 10.5% of HAH patients compared to 50% of inpatients developed delirium. 13.2% of HAH patients developed AKI compared to 41.6% in the hospital inpatient cohort.

Hospital admission was avoided in 76.3% managed by HAH. Within 2 months after discharge, 23.7% of HAH patients were readmitted to either HAH or hospital whereas 20.8% of hospital patients required readmission to hospital. Mortality rate in HAH was 0% compared to 12.5% in hospital inpatients.

Conclusions: The average length of stay was 18 days shorter under HAH care. While the rates of readmission were comparable between the two groups, patients treated in their own home developed significantly lower rates of delirium, AKI, and mortality compared to inpatients on an acute frailty ward. This highlights the benefits of providing hospital-level care to selected patients in their home.