The effects of supporting discharge from hospital to home in older people

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. Methods: 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 whic h revealed that bias was present, dictating the need for caution in interpr eting results. Despite this, there was relative certainty that the proporti on of those at home 6-12 months after admission is greater with supported d ischarge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was assoc iated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was u ncertainty about the effect of supported discharge on hospitalization. Ther e were no rigorous research data on functional status, patient and carer sa tisfaction, and, in consequence, uncertainty about the overall effectivenes s of supported discharge. Conclusions: we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, impo rtant sources of uncertainty remain, suggesting the need for further resear ch.