Day hospital care seems to be effective for elderly people who need rehabilitation, but may not be better than other forms of comprehensive care
- Montgomery, Patrick
- St. John, Phil
OBJECTIVE
To investigate whether day hospital attendance prolongs independent living for elderly people.
METHOD
Systematic review of randomized or quasirandomized controlled clinical trials of geriatric care.
LITERATURE REVIEW
Studies (search date January 1997) were identified by searching MEDLINE, SIGLE (System for Information on Grey Literature in Europe), BIDS (Bath Information and Data Services), CINAHL (Cumulative Index to Nursing and Allied Health), the Cochrane Library, Index Medicus, dissertation abstracts, conference abstracts, and trial bibliographies. Key search terms included day hospital, day care, ambulatory care, and outpatient clinic.
MAIN OUTCOMES
Death; need for institutional care; disability; 'poor outcome' (constructed global measure).
MAIN RESULTS
Twelve trials (n = 2867) were selected. Overall, the review found was no significant difference between the outcomes in elderly people attending day hospital versus alternative rehabilitation care. However, compared with people receiving no comprehensive care, people attending day hospitals had a significantly lower odds of death or 'poor outcome' (OR 0.72, 95% CI 0.53 to 0.99) and functional deterioration (OR 0.61, 95% CI 0.38 to 0.97).
AUTHORS' CONCLUSIONS
There is no clear evidence that day hospitals are better than other comprehensive care regimens. There is limited evidence that they provide more effective care than non-comprehensive regimens. The review is limited, as the studies come from different countries and were conducted over a period of 30 years. Only three trials used a no comprehensive care comparison group, and these trials had significant loss to follow-up. Important outcomes not included were patient preference and instrumental daily living activities.