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

Anne Forster; John Young; Ruth Lambley; Peter Langhorne

doi:10.1002/14651858.CD001730.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Analysis 1.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva


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

Analysis 1.6

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

Ir a la figura de la revisión


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

Analysis 1.7

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

Ir a la figura de la revisión


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

Analysis 1.8

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

Ir a la figura de la revisión


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

Analysis 1.9

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

Ir a la figura de la revisión

Analysis 2.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva


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)

Analysis 2.2

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

Ir a la figura de la revisión


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

Analysis 2.3

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

Ir a la figura de la revisión

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

Comparison 1. Day Hospital vs Alternative Care ‐ patient outcomes

Ir a la tabla de la revisión

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

Comparison 2. Day Hospital vs Alternative Care ‐ Resource outcomes

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet