Medical day hospital care for the elderly versus alternative forms of care

Geriatric day hospitals are an important component of elderly care designed to assist with in-hospital services. They are out-patient facilities where older patients attend for a full or near full day and receive multidisciplinary rehabilitation in a health care setting. Thirteen trials involving 3007 participants were included in this review, and results show that attendance at a day hospital offers benefits over no treatment including improved activities of daily living and decreased use of hospital beds. There appears to be little advantage of medical day hospital when compared to other forms of comprehensive elderly services.

Authors' conclusions: 

Medical day hospital care for the elderly appears to be more effective than no intervention but may have no clear advantage over other forms of comprehensive elderly medical services.

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Background: 

The proportion of the world's population aged 60 or over is increasing. This review sets out to examine the effectiveness and resource implications of geriatric medical day hospital attendance for elderly people. This is an update of a Cochrane review first published in 1999.

Objectives: 

To examine the effectiveness of attendance at a medical day hospital for elderly people in preventing death, disability, and institutionalisation and improving subjective health status.

Search strategy: 

We searched the EPOC group specialist register (March 2008), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2008), MEDLINE (1996 to January 2008), EMBASE (1996 to 2008 week 5), and other databases.

Selection criteria: 

Randomised and quasi-randomised studies comparing attendance at a geriatric medical day hospital with alternative forms of care for elderly medical patients (usually > 60 years).

Data collection and analysis: 

Three review authors independently assessed research reports to determine eligibility, categorise trial type and extract data.

Main results: 

Thirteen trials involving 3007 participants were included. These compared day hospital with a) comprehensive elderly care (five trials), b) domiciliary care (five trials), or c) no comprehensive elderly care (three trials).

There were no significant differences between day hospital attendance and the sub-categories of comparison treatments for the outcomes of death, death or requiring institutional care, death or deterioration in ADL. When death or a 'poor' outcome at follow up was examined there was a significant difference in favour of day hospital attendance when compared to no comprehensive elderly care (odds ratio (OR) 0.73; 95% confidence interval (CI) 0.53 to 1.00; P < 0.05).

Dependency was measured in 12 trials using a variety of ADL measures; two described short-term improvement for the day hospital group, one reported improved outcome for the comparison group, while in the remaining trials there was no statistically significant difference. Using the outcome of deterioration in ADL among survivors, day hospital patients showed a reduced odds of deterioration when compared with those receiving no comprehensive elderly care (OR 0.60; 95% CI 0.38 to 0.97; P < 0.05).

When resource use was examined the day hospital group showed trends towards reductions in hospital bed use and placement of survivors in institutional care.