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

Age Ageing. 2000 May;29(3):271-9. doi: 10.1093/ageing/29.3.271.


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 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Health Services for the Aged / standards
  • Health Services for the Aged / statistics & numerical data*
  • Health Services for the Aged / trends
  • Home Care Services, Hospital-Based / standards
  • Home Care Services, Hospital-Based / statistics & numerical data*
  • Home Care Services, Hospital-Based / trends
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends
  • Humans
  • Institutionalization / statistics & numerical data
  • Institutionalization / trends
  • Mortality
  • Patient Discharge / statistics & numerical data*
  • Personal Satisfaction
  • Randomized Controlled Trials as Topic