Retrospective Comparison of Pneumonia Complications in Older Adults: Acute Hospital Admission versus Hospital at Home

Purpose Community acquired pneumonia (CAP) is a common cause of hospital admission among older adults and is associated with significant morbidity, particularly in frail populations. Hospital at Home (HAH) services have emerged as an alternative model of acute care delivery, aiming to reduce hospital-related complications while maintaining clinical effectiveness. Methods We conducted a retrospective comparative study within a single NHS trust over one year, comparing outcomes of older adults treated for CAP or lower respiratory tract infection (LRTI) with intravenous antibiotics either through a HAH service or on an elderly care ward. Data were extracted from electronic health records. Outcomes included length of stay, rates of delirium, acute kidney injury and 12-month mortality. Nonparametric and categorical statistical comparisons were performed as appropriate. Results A total of 172 patients were included (64 HAH, 108 inpatients). Length of stay was significantly shorter in the HAH cohort (median 4 vs 10 days; p < 0.001). Delirium occurred less frequently in HAH patients (9% vs 37%; p < 0.001). Rates of acute kidney injury were lower in HAH but did not reach statistical significance (17% vs 25%; p = 0.22). A greater proportion of HAH patients were receiving palliative care (33% vs 12%; p = 0.002). Twelve-month mortality was higher in the HAH cohort (59% vs 34%; p = 0.004). Conclusions In selected frail older adults with CAP or LRTI, management through a Hospital at Home service was associated with shorter length of stay and fewer in-hospital complications, despite higher baseline frailty and greater palliative care needs.