Systematic review of day hospital care for elderly people

BMJ 1999;318:837-841 ( 27 March )

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Systematic review of day hospital care for elderly people

Anne Forster, research physiotherapist, ^a John Young, consultant physician, ^a Peter Langhorne, senior lecturer, ^b on behalf of the Day Hospital Group.

^a Department of Health Care for the Elderly, St Luke's Hospital, Bradford BD5 0NA, ^b Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow G4 0SF

Correspondence to: Dr Forster a.forster{at}leeds.ac.uk

Objective: To examine the effectiveness of day hospitalattendance in prolonging independent living for elderlypeople.
Design: Systematic review of 12 controlled clinicaltrials (available by January 1997) comparing day hospital carewith comprehensive care (five trials), domiciliary care (fourtrials), or no comprehensive care (threetrials).
Subjects: 2867 elderlypeople.
Main outcome measures: Death, institutionalisation, disability, global"poor outcome," and use ofresources.
Results: Overall, there was no significant differencebetween day hospitals and alternative services for death, disability,or use of resources. However, compared with subjects receivingno comprehensive care, patients attending day hospitals had alower odds of death or "poor" outcome (0.72, 95% confidence interval0.53 to 0.99; P<0.05) and functional deterioration (0.61, 0.38to 0.97; P<0.05). The day hospital group showed trends towardsreductions in hospital bed use and placement in institutionalcare. Eight trials reported treatment costs, six of which reportedthat day hospital attendance was more expensive than other care,although only two analyses took into account cost of long termcare.
Conclusions: Day hospital care seems to be an effectiveservice for elderly people who need rehabilitation but may haveno clear advantage over other comprehensive care. Methodologicalproblems limit these conclusions, and further randomised trialsarejustifiable.

Key messages

The benefits of geriatric day hospital care have been controversial for many years
This systematic review of 12 randomised trials comparing a variety of day hospitals with a range of alternative services found no overall advantage for day hospital care
Day hospitals had a possible advantage over no comprehensive care in terms of death or poor outcome, disability, and use of resources
The costs of day hospital care may be partly offset by a reduced use of hospital beds and institutional care among survivors

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