Are medical day hospitals for those 60+ more effective than other forms of care?
Day hospitals are one way of delivering health care to older people. They are outpatient facilities which patients, 60 years and older, attend for a full or near-full day, and receive multidisciplinary health care 'under one roof.' They serve several functions including assessment and rehabilitation; medical, nursing, maintenance, social and respite care; and provide social interaction among patients. Although there is considerable descriptive literature available on day hospital care, concern has been expressed that evidence for effectiveness is uncertain and that day hospital care is expensive.
A team of Cochrane authors based in the United Kingdom worked with the Cochrane Effective practice and Organisation of Care Group to examine the resource implications and effectiveness of medical day hospitals for older people in preventing death, disability, and institutionalization, and improving subjective health status.
The review evaluates 16 trials involving 3689 participants and 37 day hospitals comparing day hospitals with comprehensive care, home care, or no comprehensive care. The authors rated data as low quality, and findings indicate that attendance at a day hospital offers benefits compared to providing no treatment which include reducing the risk of needing more help with daily activities such as washing or dressing. Furthermore, patients are less likely to suffer one of the following: dying, being institutionalized, or becoming more dependent on others. There is no apparent benefit when comparing day hospitals with other comprehensive services or home care. The economic value of day hospitals when compared with other healthcare services remains unclear.
"The proportion of the population over 60 years is increasing, and providing health care that is cost effective, effective, and meets the diverse needs of an older population is important. Medical day hospitals are one way of providing continuing care for older people, so we wanted to assess their effectiveness across a number of health, cost, and resource outcomes," said Professor Anne Forster, a researcher at the University of Leeds in the United Kingdom and one of the authors of the Cochrane Review. "Day hospital care appears to be an effective outpatient service for older people, but no more effective, and possibly more expensive, than other forms of comprehensive care. These findings do not support the closure of day hospital services, but do support the exploration of alternative systems for delivering an equivalent or superior form of comprehensive care."