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Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 1 Death by the end of follow up.
Figures and Tables -
Analysis 1.1

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 1 Death by the end of follow up.

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 2 Death or institutional care by the end of follow up.
Figures and Tables -
Analysis 1.2

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 2 Death or institutional care by the end of follow up.

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 3 Death or deterioration in activities of daily living (ADL).
Figures and Tables -
Analysis 1.3

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 3 Death or deterioration in activities of daily living (ADL).

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 4 Death or Poor Outcome (institutional care, disability or deterioration).
Figures and Tables -
Analysis 1.4

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 4 Death or Poor Outcome (institutional care, disability or deterioration).

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 5 Deterioration in activities of daily living (ADL) in survivors.
Figures and Tables -
Analysis 1.5

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 5 Deterioration in activities of daily living (ADL) in survivors.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

No significant difference in the Kenny ADL score ‐
Day hospital: 27.1
Control: 26

Eagle 1991

No significant difference in the Geriatric Quality of Life Questionnaire ADL score ‐
Day hospital: 4.01
Control: 4.43

Hedrick 1993

No significant in the physical dimension of the Sickness Impact Profile (NB high score indicates increased disability) ‐
Day hospital: 29.0 (SD 18.6)
Control: 32.1 (18.8)

Pitkala 1991

No data in this form

Tucker 1984

No significant difference in the mean change in Northwick Park ADL score from baseline (NB high score indicates increased disability) :
Day hospital: 0.63
Control: ‐0.64

Day hospital vs Domiciliary care

Burch 1999

No significant difference in Barthel index ‐
Day hospital: 14.5 (SD 4.9)
Control: 15.7 (sd 4.5)

Gladman 1993

No significant difference in median Barthel index ‐
Day hospital: 17
Control: 16

Roderick 2001

Significant improvement in Barthel score in both groups.
No significant difference between groups.

Vetter 1989

No significant difference in mean Barthel index ‐
Day hospital: 13.2 (SD 3.8)
Control: 12.3 (sd 4.1)

Young 1992

Significantly (P=0.01) lower Barthel ADL score ‐
Day hospital: 15 (IQR 12‐18)
Control: 17 (IQR 15‐19)

Day hospital vs No comprehensive elderly care

Hui 1995

No significant difference in mean Barthel index ‐
Day hospital: 17.1 (SD 3.6)
Control: 15.6 (SD 5.6)

Weissert 1980

No comparable data

Woodford 1962

No comparable data

Figures and Tables -
Analysis 1.6

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 6 Activities of daily living (ADL) scores.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

No significant difference in the modified Dupay assessment ‐
Day hospital: 30.4
Control: 25.9

Eagle 1991

No significant difference in the General Health Questionnaire ‐
Day hospital: 3.85
Control: 4.33

Hedrick 1993

No significant difference in the Sickness Impact Profile ‐
Day hospital: 34.1
Control: 34.5

Pitkala 1991

No comparable data

Tucker 1984

No significant difference in the change in Zung index between baseline and end of follow up ‐
Day hospital: 0.04
Control: ‐0.01

Day hospital vs Domiciliary care

Burch 1999

No significant difference in the change in the Philidelphia Geriatric Morale scale during follow up ‐
Day hospital: 1.80
Control: 0.92

Gladman 1993

No significant difference in the number of patients with distress (Nottingham Health Profile >30) ‐
Day hospital: 17 (33%)
Control: 25 (48%)

Roderick 2001

No between groups significant difference for SF‐36 physical or mental health scales.
The Philadelphia Geriatric Morale Scale scores fell in both groups (indicating lower morale) but less so in the domiciliary group.

Vetter 1989

No significant difference in the Sickness Impact Profile

Young 1992

No significant difference in the number of patients with distress (Nottingham Health Profile >30) ‐
Day hospital: 19 (41%)
Control: 20 (39%)

Day hospital vs No comprehensive elderly care

Hui 1995

No significant difference in the Geriatric Depression Scale

Weissert 1980

No comparable data

Woodford 1962

No comparable data

Figures and Tables -
Analysis 1.7

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 7 Subjective health status.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

No available data

Eagle 1991

No available data

Hedrick 1993

No comparable data

Pitkala 1991

No comparable data

Tucker 1984

No available data

Day hospital vs Domiciliary care

Burch 1999

No available data

Gladman 1993

No available data

Roderick 2001

No available data

Vetter 1989

No available data

Young 1992

No available data

Day hospital vs No comprehensive elderly care

Hui 1995

No significant difference in the level of satisfaction

Weissert 1980

No available data

Woodford 1962

No available data

Figures and Tables -
Analysis 1.8

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 8 Patient satisfaction.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

No comparable data

Eagle 1991

No available data

Hedrick 1993

No comparable data

Pitkala 1991

No comparable data

Tucker 1984

No data available

Day hospital vs Domiciliary care

Burch 1999

No significant difference in the mean change in Caregiver Strain Index between baseline and 3 months ‐
Day hospital: ‐1.45 (95% CI 0.41, 2.59)
Control: ‐1.59 (0.62, 2.56)

Gladman 1993

No significant difference at 6 months in the median Life Satisfaction Index ‐
Day hospital: 18 (IQR 11‐22)
Control: 15 (IQR 10‐19)

Roderick 2001

No available data

Vetter 1989

No data available

Young 1992

Proportion of carers showing distress (General Health Questionnaire 28 score > 5) ‐
Day hospital: 33 (42%)
Control: 30 (27%)

Day hospital vs No comprehensive elderly care

Hui 1995

No available data

Weissert 1980

No available data

Woodford 1962

No available data

Figures and Tables -
Analysis 1.9

Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 9 Carer Distress.

Comparison 2 Day Hospital vs Alternative Care ‐ Resource outcomes, Outcome 1 Requiring institutional care at the end of follow up.
Figures and Tables -
Analysis 2.1

Comparison 2 Day Hospital vs Alternative Care ‐ Resource outcomes, Outcome 1 Requiring institutional care at the end of follow up.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

Day hospital: 206 bed days for 48 patients (4.3 days per patient)
Control: 274 bed days for 48 patients (5.7 days per patient)

Eagle 1991

Day hospital: 1388 bed days for 55 patients (25.2 days per patient)
Control: 1351 bed days for 58 patients (23.3 days per patient)

Hedrick 1993

Day hospital: 8020 bed days for 411 patients (19.5 days per patient)
Control: 8067 bed days for 415 patients (19.4 days per patient)

Pitkala 1991

Day hospital: 3538 bed days for 88 patients (40.2 days per patient)
Control: 3713 bed days for 86 patients (43.2 days per patient)

Tucker 1984

Day hospital: 472 bed days for 62 patients (7.6 days per patient)
Control: 800 bed days for 58 patients (13.8 bed days per patient)

Vetter 1989

No comparable data

Day hospital vs Domiciliary care

Burch 1999

Day hospital: 923 bed days for 50 patients (18.5 per patient)
Control: 1438 bed days for 55 patients (26.1 per patient)

Gladman 1993

Day hospital: 436 bed days for 76 patients (5.7 days per patient)
Control: 766 bed days for 79 patients (9.7 days per patient)

Roderick 2001

Day hospital: 296 bed days for 74 patients ( 4 days per patient)
Control:203 bed days for 66 patients (3 bed days per patient)

Vetter 1989

No bed days used in either group

Young 1992

Day hospital: 311 bed days for 61 patients (5.1 days per patient)
Control: 278 bed days for 63 patients (4.4 days per patient)

Day hospital vs No comprehensive elderly care

Hui 1995

Day hospital: 81 bed days for 59 patients (1.4 days per patient)
Control: 165 bed days for 61 patients (2.7 days per patient)

Weissert 1980

Day hospital: 3443 bed days for 313 patients (11.0 days per patient)
Control: 2868 bed days for 239 patients (12.0 days per patient)

Woodford 1962

Day hospital: 2534 bed days for 168 patients (15.1 days per patient)
Control: 2375 bed days for 163 patients (14.6 days per patient)

Figures and Tables -
Analysis 2.2

Comparison 2 Day Hospital vs Alternative Care ‐ Resource outcomes, Outcome 2 Hospital bed use during follow up.

Study

Day hospital vs Comprehensive elderly care

Cummings 1985

Average treatment cost per patient to 3 months post discharge ‐
Day hospital: $ 16,966
Control: $ 14,082

Eagle 1991

No cost data

Hedrick 1993

Mean total costs over 12 months ‐
Day hospital: $ 28,709
Control: $ 26, 204

Pitkala 1991

No costing data

Tucker 1984

Average cost for 5 months care ‐
Day hospital: NZ$ 3052
Control: NZ$ 2083

Day hospital vs Domiciliary care

Burch 1999

Total annual cost per attendance ‐
Day hospital: £ 77.39
Control: £ 59.46

Gladman 1993

Mean total health service cost per patient ‐
Day hospital: £ 456.90
Control: £ 362.60

Roderick 2001

Median costs per patient: Rehabilitation costs: Day hospital:£1090 (IQR 513‐1475),
Control group: 933 (IQR 339‐2010).
Median Total health and social service costs: Day hospital 1568 (IQR 982‐3130), Control £2208 (IQR 694‐3849)

Vetter 1989

No cost data

Young 1992

Mean total costs for 8 weeks treatment ‐
Day hospital: £ 620 (IQR 555‐730)
Control: £385 (IQR 240‐510)

Day hospital vs No comprehensive elderly care

Hui 1995

Mean cost of treatment to the health service over 6 months ‐
Day hospital: $ 58,168 (SEM 25,898)
Control: $ 51, 809 (SEM 30,480)

Weissert 1980

Average cost for 1 year ‐
Day hospital: $ 5813
Control: $ 3815

Woodford 1962

No formal costing

Figures and Tables -
Analysis 2.3

Comparison 2 Day Hospital vs Alternative Care ‐ Resource outcomes, Outcome 3 Resource use.

Comparison 1. Day Hospital vs Alternative Care ‐ patient outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death by the end of follow up Show forest plot

13

2852

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.03 [0.84, 1.27]

1.1 Day Hospital vs Comprehensive elderly care

5

1287

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.26 [0.93, 1.70]

1.2 Day hospital vs Domiciliary care

5

583

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.86 [0.52, 1.42]

1.3 Day hospital vs No comprehensive elderly care

3

982

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.86 [0.60, 1.22]

2 Death or institutional care by the end of follow up Show forest plot

11

2438

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.81 [0.68, 0.97]

2.1 Day hospital vs Comprehensive elderly care

4

1181

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.04 [0.82, 1.33]

2.2 Day hospital vs Domiciliary care

4

443

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.87 [0.54, 1.40]

2.3 Day hospital vs No comprehensive elderly care

3

814

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.52 [0.38, 0.71]

3 Death or deterioration in activities of daily living (ADL) Show forest plot

7

1268

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.98 [0.78, 1.23]

3.1 Day hospital vs Comprehensive elderly care

1

174

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.17 [0.64, 2.17]

3.2 Day hospital vs Domiciliary care

4

443

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.34 [0.90, 1.99]

3.3 Day hospital vs No comprehensive elderly care

2

651

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.76 [0.56, 1.05]

4 Death or Poor Outcome (institutional care, disability or deterioration) Show forest plot

13

2831

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.93 [0.79, 1.09]

4.1 Day hospital vs Comprehensive elderly care

5

1268

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.06 [0.84, 1.34]

4.2 Day hospital vs Domiciliary care

5

581

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.03 [0.72, 1.49]

4.3 Day hospital vs No comprehensive elderly care

3

982

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.73 [0.55, 0.96]

5 Deterioration in activities of daily living (ADL) in survivors Show forest plot

7

905

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.99 [0.73, 1.34]

5.1 Day hospital vs Comprehensive elderly care

1

149

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.21 [0.58, 2.50]

5.2 Day hospital vs Domiciliary care

4

349

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.51 [0.94, 2.44]

5.3 Day hospital vs No comprehensive elderly care

2

407

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.60 [0.38, 0.96]

6 Activities of daily living (ADL) scores Show forest plot

Other data

No numeric data

6.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

6.2 Day hospital vs Domiciliary care

Other data

No numeric data

6.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

7 Subjective health status Show forest plot

Other data

No numeric data

7.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

7.2 Day hospital vs Domiciliary care

Other data

No numeric data

7.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

8 Patient satisfaction Show forest plot

Other data

No numeric data

8.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

8.2 Day hospital vs Domiciliary care

Other data

No numeric data

8.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

9 Carer Distress Show forest plot

Other data

No numeric data

9.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

9.2 Day hospital vs Domiciliary care

Other data

No numeric data

9.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

Figures and Tables -
Comparison 1. Day Hospital vs Alternative Care ‐ patient outcomes
Comparison 2. Day Hospital vs Alternative Care ‐ Resource outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Requiring institutional care at the end of follow up Show forest plot

11

2438

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.80 [0.64, 0.99]

1.1 Day hospital vs Comprehensive elderly care

4

1181

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.91 [0.70, 1.19]

1.2 Day hospital vs Domiciliary care

4

443

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.13 [0.58, 2.23]

1.3 Day hospital vs No comprehensive elderly care

3

814

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.50 [0.33, 0.77]

2 Hospital bed use during follow up Show forest plot

Other data

No numeric data

2.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

2.2 Day hospital vs Domiciliary care

Other data

No numeric data

2.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

3 Resource use Show forest plot

Other data

No numeric data

3.1 Day hospital vs Comprehensive elderly care

Other data

No numeric data

3.2 Day hospital vs Domiciliary care

Other data

No numeric data

3.3 Day hospital vs No comprehensive elderly care

Other data

No numeric data

Figures and Tables -
Comparison 2. Day Hospital vs Alternative Care ‐ Resource outcomes