Background Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. Objectives To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. Selection criteria Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. Data collection and analysis We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes.

Analysis 2.1. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1 Mortality at 3-6 months-older people with a mix of conditions.. .. .. .. .. .. Analysis 2.2. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2 Mortality-chronic obstructive pulmonary disease.. .. .. .. .. .. .. .. .. Analysis 2.3. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3 Hospital readmission at 3 months-older people with a mix of conditions.. .. .. .. .. Analysis 2.4. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions,

This systematic review and meta-analysis has demonstrated the evidence of a consistent inverse association between frailty/prefrailty and quality of life among community-dwelling older people. Interventions targeted at reducing frailty may have the additional benefit of improving corresponding quality of life. More longitudinal analysis is required to determine this effect.

exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.

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