Systematic review of day hospital care for elderly people

Abstract

Objective. To examine the effectiveness of day hospital attendance in prolonging independent living for elderly people. Design. Systematic review of 12 controlled clinical trails (available by January 1997) comparing day hospital care with comprehensive care (five trials), domiciliary care (four trials), or no comprehensive care (three trials). Subjects. 2867 elderly people. Main outcome measures. Death, institutionalisation, disability, global 'poor outcome,' and use of resources. Results. Overall, there was no significant difference between day hospitals and alternative services for death, disability, or use of resources. However, compared with subjects receiving no comprehensive care, patients attending day hospitals had a lower odds of death or 'poor' outcome (0.72, 95% confidence interval 0.53 to 0.99; P < 0.05) and functional deterioration (0.61, 0.38 to 0.97; P < 0.05). The day hospital group showed trends towards reductions in hospital bed use and placement in institutional care. Eight trials reported treatment costs, six of which reported that day hospital attendance was more expensive than other care, although only two analyses took into account costs of long term care. Conclusions. Day hospital care seems to be an effective service for elderly people who need rehabilitation but may have no clear advantage over other comprehensive care. Methodological problems limit these conclusions, and further randomised trials are justifiable.