Researchers tested a new way to care for elderly patients with liver disease who experience dangerous internal bleeding. Instead of standard care, one group received help from a coordinated team of doctors, nurses, pharmacists, and counselors working together. This team-based approach included close monitoring in the first few days, nutrition support, medication checks, and mental health counseling. After one year, patients who received this coordinated care recovered better, felt less anxious, had fewer repeat bleeding episodes, and reported better quality of life. While this approach didn’t extend survival time, it significantly improved how patients felt and functioned during recovery.

The Quick Take

  • What they studied: Whether having a coordinated team of healthcare workers (doctors, nurses, pharmacists, and counselors) provide specialized care improves recovery in elderly patients with liver disease who have serious internal bleeding.
  • Who participated: 120 elderly patients with liver cirrhosis and upper gastrointestinal bleeding, split into two groups of 60 each. One group received standard hospital care, while the other received care from a coordinated team.
  • Key finding: Patients who received team-based care stopped bleeding faster, needed fewer blood transfusions, had better nutrition, felt less anxious and depressed, experienced fewer repeat bleeding episodes over one year, and reported better overall quality of life compared to standard care patients.
  • What it means for you: If you or an elderly family member faces this serious condition, asking for a coordinated care team approach may lead to faster recovery, better emotional support, and fewer complications. However, this approach works best in hospitals equipped with such teams, and it’s important to discuss options with your doctor.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of medical research. Researchers randomly assigned 120 elderly patients with liver disease and serious internal bleeding into two equal groups. One group (60 patients) received the usual hospital care. The other group (60 patients) received specialized care from a team including nurses, doctors, pharmacists, and mental health counselors working together.

The team-based care had three phases: First, during the acute emergency phase (first 1-3 days), nurses checked vital signs every 30 minutes and started nutrition support within 6 hours of stopping the bleeding. Second, during recovery (days 3-7), a pharmacist reviewed all medications and patients received counseling twice a week. Third, patients received ongoing support through video visits for one full year after leaving the hospital.

Researchers measured multiple outcomes including how quickly bleeding stopped, how much blood patients needed, blood pressure control, ability to care for themselves, nutrition levels, mood and anxiety, complications, repeat bleeding episodes, and overall quality of life.

This research approach is important because elderly patients with liver disease and bleeding are very fragile and often have multiple health problems. By studying whether a coordinated team approach works better than standard care, researchers can identify the best way to help these vulnerable patients. The randomized design means the two groups were similar at the start, so differences in outcomes are likely due to the care approach, not other factors.

This study has several strengths: it used random assignment to create fair comparison groups, included a reasonable number of patients (120), measured many important outcomes, and followed patients for a full year. The study was conducted in 2023-2024, so findings are recent. However, the study was conducted at a single hospital, so results may not apply everywhere. The journal (JoVE) publishes video-based research, which is good for showing procedures but may have different review standards than traditional medical journals.

What the Results Show

Patients receiving team-based care stopped bleeding significantly faster than those receiving standard care. They also needed fewer blood transfusions on average, meaning their bodies recovered blood volume more efficiently. Blood pressure control was better in the team-based care group, which is important because unstable blood pressure is dangerous in these patients.

Nutrition improved more in the team-based care group. This matters because elderly patients with liver disease often become malnourished, which slows healing. Starting nutrition support within 6 hours of stopping the bleeding appeared to make a real difference.

Mental health outcomes were notably better in the team-based care group. Patients reported less anxiety and depression, which is significant because serious illness often causes emotional distress. Regular counseling sessions seemed to help patients cope better.

Over the one-year follow-up period, patients in the team-based care group had fewer repeat bleeding episodes. This is important because repeat bleeding is dangerous and often requires emergency treatment. The coordinated approach appeared to help prevent these dangerous recurrences.

Patients in the team-based care group showed better self-care abilities, meaning they could manage daily activities more independently during recovery. Overall quality of life scores were higher in this group, reflecting improvements across physical, emotional, and social well-being. Hospital stays may have been shorter, though this wasn’t explicitly stated. The medication review by pharmacists likely prevented drug interactions and side effects.

Previous research has shown that coordinated care teams improve outcomes in various serious conditions. This study adds important evidence that the approach works specifically for elderly patients with liver disease and bleeding. The findings align with growing recognition that single-provider care is less effective than team-based approaches for complex, serious conditions. The one-year follow-up period is longer than many similar studies, providing better evidence about lasting benefits.

The study was conducted at a single hospital, so results may not apply to all hospitals or healthcare systems. The study didn’t measure survival time differences, so we don’t know if this approach helps patients live longer. The research was conducted in 2023-2024, so long-term effects beyond one year are unknown. The study didn’t compare costs, so we don’t know if the team-based approach costs more or less. Results may differ in different countries or healthcare systems. The study didn’t examine which specific parts of the team-based approach (monitoring, nutrition, counseling, or medication review) were most important.

The Bottom Line

For elderly patients with liver disease and serious internal bleeding: Request a coordinated care team approach if your hospital offers it (moderate confidence). Ask specifically about early nutrition support, frequent vital sign monitoring, medication review by a pharmacist, and mental health support (moderate confidence). Participate actively in follow-up appointments and telemedicine visits for at least one year (moderate confidence). These recommendations are based on this single study, so discuss with your healthcare team whether they apply to your specific situation.

This research is most relevant for: elderly patients (65+) with liver cirrhosis experiencing upper gastrointestinal bleeding; family members of such patients; hospital administrators considering care model changes; nurses and doctors working with this patient population. This research is less relevant for younger patients with liver disease or those without bleeding complications, though some principles may apply.

Improvements in bleeding control and blood pressure may be seen within the first 24-72 hours. Nutrition improvements typically develop over 1-2 weeks. Mental health improvements may take 2-4 weeks of regular counseling. Reduction in repeat bleeding episodes becomes apparent over months. Overall quality of life improvements may take 2-3 months to fully develop. Maximum benefits appear to occur around 6-12 months with ongoing team support.

Want to Apply This Research?

  • Track weekly: (1) Vital signs (blood pressure, heart rate, temperature) at the same time each day; (2) Nutrition intake using a simple food diary or photos; (3) Mood using a 1-10 scale; (4) Any signs of bleeding (dark stools, vomiting blood, unusual bruising); (5) Medication taken and any side effects.
  • Users should: Set daily reminders for medication times; Log meals and snacks to ensure adequate nutrition; Schedule and attend all counseling or mental health appointments; Report any concerning symptoms immediately; Keep a list of all medications and supplements to share with healthcare providers; Attend all follow-up appointments, including telemedicine visits.
  • Create a simple dashboard showing: Daily vital sign trends over 30 days; Weekly nutrition quality scores; Monthly mood trend; Medication adherence percentage; Appointment completion rate; Any bleeding episodes or complications. Share this data with your healthcare team at each visit to identify patterns and adjust care as needed.

This research describes a specialized medical intervention for a serious condition (liver cirrhosis with internal bleeding) that requires immediate hospital care. These findings should not replace professional medical advice. If you or someone you know experiences signs of internal bleeding (vomiting blood, black/tarry stools, severe abdominal pain, dizziness, or fainting), seek emergency medical care immediately. The team-based care approach described may not be available at all hospitals. Discuss with your healthcare team whether this approach is appropriate for your specific situation, as individual circumstances vary. This study was conducted at a single hospital and results may not apply universally. Always consult with your doctor before making healthcare decisions based on research findings.