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Updated: Jun 29, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Admission avoidance hospital at home.

Sasha Shepperd¹, Helen Doll, Robert M Angus

¹Department of Public Health, University of Oxford, Rosemary Rue Building, Headington, Oxford, Oxfordshire, UK, OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk

The Cochrane Database of Systematic Reviews

|October 10, 2008

Summary

Hospital at home services offer active treatment in patients' homes, aiming to avoid acute hospital admissions. While patient satisfaction and cost-effectiveness are noted, this review found no significant difference in outcomes compared to inpatient care.

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Area of Science:

Health Services Research
Geriatric Medicine
Internal Medicine

Background:

Hospital at home provides active, time-limited healthcare in a patient's residence, substituting for acute inpatient care.
This model aims to reduce demand on acute hospital beds and offers an alternative to traditional hospital stays.
Increasing adoption globally highlights its perceived value in managing healthcare capacity.

Purpose of the Study:

To systematically review and meta-analyze the effectiveness and cost of hospital at home versus inpatient hospital care.
To evaluate patient outcomes, including mortality, readmissions, functional ability, and quality of life.

Main Methods:

A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to January 2008.
Databases searched included MEDLINE, EMBASE, CINAHL, EconLit, and the Cochrane EPOC register.
Individual patient data (IPD) meta-analysis was performed where possible, supplemented by published data and narrative summaries.

Main Results:

Ten RCTs (n=1333) were included; seven were eligible for IPD meta-analysis.
A significant reduction in mortality was observed at six months (adjusted HR 0.62, p=0.005), but not at three months.
Hospital at home showed increased readmissions (adjusted HR 1.49, p=0.08), minimal differences in functional ability or quality of life, but higher patient satisfaction and lower costs (excluding informal care).

Conclusions:

Meta-analyses indicate no significant difference in overall outcomes between hospital at home and inpatient hospital care.
While patient satisfaction and cost-effectiveness (excluding informal care) are potential benefits, clinical effectiveness remains comparable.
Further research may be needed to clarify the specific patient groups or conditions where hospital at home offers a distinct advantage.