New treatment for elderly bowel patients significantly reduces need for admission

Elderly patients with Clostridioides difficile infection (CDI) are a very vulnerable group.

The infection, which causes diarrhea and bowel inflammation, can have serious consequences for patients. In a new study from Aarhus University and Aarhus University Hospital, researchers present a new and improved treatment approach.

By combining early assessment (Comprehensive Geriatric Assessment, CGA) with home treatment and access to fecal microbiota transplantation (FMT), researchers successfully reduced the need for readmissions to one-third and halved the risk of persistent diarrhea.

“We know that half of all CDI patients are over 75 years old, and we can see that it is especially older patients who die from the disease,” says Christian Lodberg Hvas, Clinical Professor at the Department of Clinical Medicine and senior consultant at Aarhus University Hospital, one of the researchers behind the study.

“In our previous studies, we have seen that the mortality rate for older and most vulnerable patients can be as high as 51 percent within 90 days. We wanted to do something about that,” he adds.

Assessment by a multidisciplinary team

A CGA is a clinical assessment of the patient’s overall condition—not just the current infection—but an evaluation conducted by a multidisciplinary team of nurses and doctors who examine the patient’s functional capacity, nutritional status, medication use, fluid balance, and psychosocial conditions.

“The big difference is that the geriatric team works more systematically with the patients’ overall health status. This enables us to initiate the right treatment from the start, instead of having to ‘experiment’ with treatment methods that might not work,” says Christian Lodberg Hvas.

The new treatment model differs from the traditional approach, where a doctor typically focuses on the acute infection and prescribes standard treatment with antibiotics.

Significant reduction in readmissions

In the study, treatment was closely monitored by a geriatric team, which could, among other things, offer fecal microbiota transplantation—a treatment that restores the gut flora.

The study showed significant differences in the patients’ outcomes.

In the CGA group, only 16 percent of patients were readmitted within 30 days, compared to 51 percent in the standard care group.

Furthermore, only 15 percent of patients in the CGA group still had diarrhea after 90 days, compared to 32 percent in the standard care group.

“The most surprising finding was the large difference in the need for readmissions. Given that hospital stays can be very debilitating for elderly patients, it is a major breakthrough that we can reduce their need to return to the hospital so significantly,” says Christian Lodberg Hvas.

Treatment at home

One of the most notable elements of the study was that patients in the CGA group could receive treatment in their own homes.

“We know that many elderly people prefer to stay at home, and now we have shown that it can be done without compromising the quality of care. It also makes a big difference for patients that they can avoid being transported to and from the hospital,” explains Christian Lodberg Hvas.

The researchers see great potential in scaling the model—not only for patients with CDI but also for other disease areas.

There is growing attention on home treatment as part of the future healthcare system, which is also an important part of the health reform.

“However, it requires expertise and research to put it into practice, and we are now investigating how we can best do that,” says Christian Lodberg Hvas.

Facts: What is Clostridioides difficile infection (CDI)?

• A bacterial infection in the intestine that can cause severe diarrhea and bowel inflammation.

• Most commonly affects elderly and frail patients, especially after antibiotic treatment.

• Can be treated with antibiotics and fecal microbiota transplantation (FMT).

Facts: What is fecal microbiota transplantation (FMT)?

• A treatment where gut flora from a healthy donor is transferred to the patient.

• Can be administered via capsules or a tube into the gastrointestinal tract.

• Has been shown to be effective in preventing recurrences of CDI infections.

Behind the research result

Study type: Randomized quality improvement trial

Collaborating partners: Aarhus University Hospital, Silkeborg Regional Hospital, Horsens Regional Hospital, Randers Regional Hospital, Viborg Regional Hospital, Gødstrup Regional Hospital, Herlev Hospital, as well as Guy’s and St. Thomas’ Hospitals and King’s College in London.

External funding: The Health Foundation and the Innovation Fund Denmark

Conflicts of interest: Any conflicts of interest are disclosed in the scientific article.

Link to scientific article: Read the full article on The Lancet

Contact

Clinical Professor and Senior Consultant Christian Lodberg Hvas
Aarhus University, Department of Clinical Medicine
Aarhus University Hospital, Hepatology and Gastroenterology.
Phone: +45 2835 1839
Email: chvas@clin.au.dk