Age and Ageing, Vol 29, 271-279, Copyright © 2000 by British Geriatrics Society
C Hyde, I Robert and A Sinclair
Objective. To investigate the effects of supported
discharge after an acute admission in older people with undifferentiated
clinical problems.Design. A systematic review of
randomized controlled trials.Method. We searched
MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science
Citation Index up to the end of 1997. This was augmented by hand-searching,
follow-up of bibliographies and direct enquiry of authors of included
studies. Application of inclusion decisions, quality assessment and data
abstraction were carried out independently by at least two of the
reviewers. We tabulated the results of the included studies and used
meta-analysis where appropriate to refine conclusions.Results.
We finally included nine studies in the review, assessment of
which revealed that bias was present, dictating the need for caution in
interpreting results. Despite this, there was relative certainty that the
proportion of those at home 6-12 months after admission is greater with
supported discharge (odds ratio 1.4, 95% confidence interval 1.1-2.0). This
was associated with a consistent pattern of reduction in admission to
long-stay care over the same period, without apparent increases in
mortality. There was uncertainty about the effect of supported discharge on
hospitalization. There were no rigorous research data on functional status,
patient and carer satisfaction, and, in consequence, uncertainty about the
overall effectiveness of supported discharge.Conclusion.
We believe that the results of this review provide reassurance
that supporting discharge from hospital to home is of value. However,
important sources of uncertainty remain, suggesting the need for further
research.Keywords: aged, home care services,
meta-analysis, patient discharge
ARTICLES
Systematic review. The effects of supporting discharge from hospital to home in older people
Academic Department of Geriatric Medicine, University of Birmingham, The Hayward Building, Selly Oak Hospital, Raddlebarn Road, Birmingham B29 6JD, UK; Corresponding author; Fax: (+44) 121 627 8304; E-mail: a.j.sinclair@bham.ac.uk
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