Petermans Jean, Velghe Anja, Gillain Daniel, Boman Xavier, Van Den Noortgate Nele
Service de gériatrie, CHU de Liège, Belgique.
Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep;9(3):295-303. doi: 10.1684/pnv.2011.0292.
A systematic review of the international literature concerning the organisation of the Geriatric Day Hospital (GDH) was performed. From 1987 till now, few papers were found describing the activity and the effectiveness of the GDH. All the studies comparing specific geriatric approaches to regular medicine demonstrate the efficiency of geriatric care, particularly the geriatric assessment. So, with a degree of evidence 1a, a better outcome is found for patients undergoing a geriatric assessment and intervention, compared to patients having no geriatric assessment at all. However, there is no evidence of benefit for the geriatric day hospital compared to patients treated in a geriatric ward or other location of geriatric care. Moreover, there is no clear consensus on the settings and activities of a geriatric day hospital. Terms as day unit, day hospital, day care, are used interchangeably and are not always covering the same activity. The same remark can be made on the exact composition of the geriatric multidisciplinary team and its role. However nurses and paramedical workers are always mentioned as all performing geriatric assessment. The diagnostic activities on the GDH are seldom described and studied. More information is available on rehabilitation activity, often developed in specific patient populations such as stroke patients, dementia patients, cardiac patients or patients with other chronic diseases. In this selected patient populations positive effects on outcome are shown in the GDH (level of evidence 1a). Another problem is the heterogeneity of the population. For scientific reason the GDH should focus on organising care for specific medical problems. Diseases as dementia, stroke, cardiac insufficiency, could be good models to investigate the efficiency of geriatric assessment and interventions within the setting of a GDH.
对有关老年日间医院（GDH）组织情况的国际文献进行了系统综述。从1987年至今，发现很少有论文描述老年日间医院的活动及成效。所有比较特定老年医疗方法与常规医疗的研究都证明了老年护理的有效性，尤其是老年评估。因此，依据1a级证据，与完全未接受老年评估的患者相比，接受老年评估和干预的患者预后更佳。然而，与在老年病房或其他老年护理场所接受治疗的患者相比，没有证据表明老年日间医院有优势。此外，对于老年日间医院的设置和活动，尚无明确共识。日间单元、日间医院、日间护理等术语可互换使用，且并不总是涵盖相同的活动。对于老年多学科团队的确切组成及其作用，也存在同样的情况。不过，护士和辅助医疗人员总是被提及都参与老年评估。很少有文献描述和研究老年日间医院的诊断活动。关于康复活动有更多信息，康复活动通常在特定患者群体中开展，如中风患者、痴呆患者、心脏病患者或其他慢性病患者。在这些选定的患者群体中，老年日间医院显示出对预后有积极影响（证据级别为1a）。另一个问题是患者群体的异质性。出于科学原因，老年日间医院应专注于针对特定医疗问题组织护理。痴呆、中风、心功能不全等疾病可能是研究老年日间医院环境中老年评估和干预效果的良好模型。
