Hospital at home for older frequent hospital users: present and future of a healthcare challenge

Enrico Mossello; Giulia Rivasi; Antonella Giordano; Sofia Espinoza Tofalos; Martina Rafanelli; Chiara Lorenzi; Vanni Corsoni; Matilde D'Ambrosi; Flavia Gabellini; Matteo Bulgaresi; Guglielmo Bonaccorsi; Enrico Benvenuti; Maria Chiara Cavallini; Daniela Matarrese; Andrea Ungar

doi:10.1007/s40520-025-03301-3

Hospital at home for older frequent hospital users: present and future of a healthcare challenge

Aging Clin Exp Res. 2026 Jan 14;38(1):52. doi: 10.1007/s40520-025-03301-3.

Authors

Enrico Mossello^#^{1

2}, Giulia Rivasi^#^{3

4}, Antonella Giordano⁵, Sofia Espinoza Tofalos^{1

2}, Martina Rafanelli², Chiara Lorenzi², Vanni Corsoni², Matilde D'Ambrosi¹, Flavia Gabellini¹, Matteo Bulgaresi⁶, Guglielmo Bonaccorsi⁷, Enrico Benvenuti⁶, Maria Chiara Cavallini⁵, Daniela Matarrese⁸, Andrea Ungar^{1

2}

Affiliations

¹ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
² Division of Geriatric and Cardiogeriatric Medicine, Careggi University Hospital, Florence, Italy.
³ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. giulia.rivasi@unifi.it.
⁴ Division of Geriatric and Cardiogeriatric Medicine, Careggi University Hospital, Florence, Italy. giulia.rivasi@unifi.it.
⁵ Department of Geriatric Medicine, Careggi University Hospital, Firenze, Italy.
⁶ Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit Toscana Centro, Florence, Italy.
⁷ Department of Health Science, University of Florence, Florence, Italy.
⁸ CareggiUniversity Hospital, Florence, Italy.

^# Contributed equally.

Abstract

Background: Frequent hospital users (FHUs) show high risk of clinical instability. A hospital-at-home (HaH) service (“GIROT”) was created in Florence, Italy, to reduce hospitalizations in older adults vulnerable to hospital-related complications.

Aim: To investigate the association of frequent hospital use with all-cause mortality and hospitalization among HaH patients.

Methods: patients referred to GIROT between January 2022 and March 2024, participated in a prospective longitudinal study. Participants were stratified by prior-year hospital admissions (0–1, 2, and 3+) and FHUs were defined based on the association between admissions and risks of subsequent hospitalization and mortality. Multivariate Cox regression assessed the independent association between FHU status and outcomes.

Results: Among 219 patients (mean age 85.9, 55% female, 44% with severe disability), the median number of hospitalizations in the previous year was 2. Over a 6-month follow-up, mortality risk was 43% and hospitalization risk was 39%. Six-month mortality was higher in subjects with 2 (58%) and 3 + admissions (48%) versus 0–1 admissions (32%), with similar patterns for hospitalization. These findings led to defining FHUs as individuals with 2 + prior hospitalizations. Shorter time-to-death was independently associated with weight loss, severe disability, heart failure with reduced ejection fraction (HFrEF), and FHU status (adjHR 1.49, 95%CI 1.00-2.21). Time-to-hospitalization was independently predicted by HFrEF and FHU status (adjHR 1.80, 95%CI 1.08–3.01).

Conclusions: FHUs (i.e., 2 + hospitalizations in the previous year) showed an increased risk of re-admission and mortality among older adults receiving HaH. Extra-hospital care pathways, including HaH and palliative care, may help reduce admissions in this population.

Graphical Abstract:

Supplementary Information: The online version contains supplementary material available at 10.1007/s40520-025-03301-3.

Keywords: Disability; Frequent hospital users; Hospital at home; Hospitalization; Mortality.