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

 

Abstract

Background

The proportion of the world's population aged 60 or over is increasing. This review sets out to examine the effectiveness and resource implications of geriatric medical day hospital attendance for elderly people. This is an update of a Cochrane review first published in 1999.

Objectives

To examine the effectiveness of attendance at a medical day hospital for elderly people in preventing death, disability, and institutionalisation and improving subjective health status.

Search methods

We searched the EPOC group specialist register (March 2008), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2008), MEDLINE (1996 to January 2008), EMBASE (1996 to 2008 week 5), and other databases.

Selection criteria

Randomised and quasi-randomised studies comparing attendance at a geriatric medical day hospital with alternative forms of care for elderly medical patients (usually > 60 years).

Data collection and analysis

Three review authors independently assessed research reports to determine eligibility, categorise trial type and extract data.

Main results

Thirteen trials involving 3007 participants were included. These compared day hospital with a) comprehensive elderly care (five trials), b) domiciliary care (five trials), or c) no comprehensive elderly care (three trials).

There were no significant differences between day hospital attendance and the sub-categories of comparison treatments for the outcomes of death, death or requiring institutional care, death or deterioration in ADL. When death or a 'poor' outcome at follow up was examined there was a significant difference in favour of day hospital attendance when compared to no comprehensive elderly care (odds ratio (OR) 0.73; 95% confidence interval (CI) 0.53 to 1.00; P < 0.05).

Dependency was measured in 12 trials using a variety of ADL measures; two described short-term improvement for the day hospital group, one reported improved outcome for the comparison group, while in the remaining trials there was no statistically significant difference. Using the outcome of deterioration in ADL among survivors, day hospital patients showed a reduced odds of deterioration when compared with those receiving no comprehensive elderly care (OR 0.60; 95% CI 0.38 to 0.97; P < 0.05).

When resource use was examined the day hospital group showed trends towards reductions in hospital bed use and placement of survivors in institutional care.

Authors' conclusions

Medical day hospital care for the elderly appears to be more effective than no intervention but may have no clear advantage over other forms of comprehensive elderly medical services.

 

Plain language summary

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

Geriatric day hospitals are an important component of elderly care designed to assist with in-hospital services. They are out-patient facilities where older patients attend for a full or near full day and receive multidisciplinary rehabilitation in a health care setting. Thirteen trials involving 3007 participants were included in this review, and results show that attendance at a day hospital offers benefits over no treatment including improved activities of daily living and decreased use of hospital beds. There appears to be little advantage of medical day hospital when compared to other forms of comprehensive elderly services.

 

摘要

背景

老人日間醫院照護對照其它替代的照護方式

世界上大於60歲的人口比例正在上升中。這篇回顧的目的為評估老人日間醫院照護對老人的效果以及資源使用。這是一篇更新的考科藍回顧(Cochrane review)，於1999年首次發表。

目標

評估老人日間醫院照護對於預防老年人死亡、殘障、居住於安養院所以及主觀健康狀態的效果。

搜尋策略

我們搜尋了EPOC group secialist register (2008年3月)、Cochrane Central Register of Controlled Trials (CENTRAL)，(The Cochrane Library, Issue 1, 2008)，MEDLINE (1996 到 2008年1月)，EMBASE (1996 到 2008 第5週) 以及其他資料庫。

選擇標準

隨機的及類隨機研究其比較老年的醫療患者(通常為60歲以上)在老人日間醫院照護對照於照護的替代方式。

資料收集與分析

三篇回顧作者分別獨立評估研究報告以確定其合格性，分類試驗的類型並摘錄資料。

主要結論

13項試驗共包含3007名參與者被納入。與日間醫院相互比較的替代方式為a)全面性老人照護(五項試驗)，b)住宅式照護(五項試驗)，c)無全面性的老人照護(三項試驗)。對於死亡結果，死亡或需要機構照護，死亡或日常生活功能惡化方面，日間醫院和替代的對照治療方式沒有顯著性差異。當評估追蹤期間死亡或“不良”結果時，相較於無全面性的老人照護，結果較偏向日間照護(odds ratio (OR) 0.73; 95% confidence interval (CI) 0.53 to 1.00; P < 0.05)。12項試驗使用各種ADL工具來測量依賴性兩項試驗描述日間醫院組有短期的改善，一項試驗報告對照組的結果有改善，但其餘的試驗兩組間沒有統計的顯著差異。採用存活者其日常生活功能惡化的結果，相較於那些接受無全面性老人照護者，日間醫院的病人顯示退化的風險有減少(OR 0.60; 95% CI 0.38 to 0.97; P < 0.05)。當評估資源利用時，日間醫院組病床利用及生存者安置於機構式照護有減少的趨勢。

作者結論

老人日間醫院照護似乎比無介入措施較為有效，但可能沒有明確優於其他全面性老人醫療服務形式的優點。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

老人日間醫院是老人照護重要的組成部分，其設計用以輔助住院服務。它們是門診機構，在那裡老年病人參加全天或幾乎全天的健康照護機構其多科別的復健服務。這篇回顧納入13項試驗，共包含3007名參與者，且結果顯示參加日間醫院可提供優於無治療組的效益，包括改善日常生活活動並減少醫院床數的使用。相較於其他全面性的老人服務，老人日間醫院似乎有一些好處。