Day Hospitals

There is much controversy as to the effectiveness of day hospitals. A recent systematic review concluded day hospital care to be an effective service for elderly people who need rehabilitation, but it did not have any advantage over other comprehensive care, such as home therapy. It may be more expensive. There is little favorable published evidence from randomized controlled trials.

No difference was shown in the rate of hospitalization or degree of disability for patients who attend day hospitals compared to those who receive home care in either a Finnish or a British day hospital. An earlier Canadian study showed no difference in mortality between GDH and usual specialized geriatric care. Randomized controlled trials of geriatric day hospitals have generally failed to show any benefit in terms of either patient outcomes or cost savings, although those patients with the greater degree of disability have seemed to improve in some trials. These disappointing results may have been due to heterogeneity of physical and mental function in the patients who come to day hospitals or the wrong outcomes may have been measured. There may have been too much of a variation in the health status of the persons admitted to the day hospitals. The measurement instruments may not have been the best ones to measure important changes. Instruments that are designed to discriminate between persons who have a condition and those who do not may not be the best ones to measure change in that condition. If a woman has had a stroke, she may not improve the paralysis of the leg involved by attending the day hospital but after attending she may be able to walk a little further with an aid and feel much better about going out in a car or even public transport. She may also enjoy life more. Measuring her muscle power or the degree of weakness would not have shown much improvement.

On the other hand, it is possible that day hospitals are not effective ways of managing health problems in the frail older adult and other approaches, such as increased home care, need to be better evaluated. There is, however, a high acceptance of this approach from day hospital attendees and staff. Increasing evidence shows targeting patients most likely to benefit may improve outcomes in both physical function and reduction of caregiver stress. In several published studies, patients with the highest degree of physical disability seemed to benefit the most. Better selection of patients in the future may improve the effectiveness of these popular programs, but this would require evaluation in further rigorous research studies.