Can the Geriatric Day Hospital Act As a Hub for Services for Older People across the Spectrum of Ageing from Active Ageing to Advanced Frailty?

This article examines the potential of the Geriatric Day Hospital to address the challenge of an aging society, which has begun to place an emphasis on the promotion of active and healthy aging, yet faces rising numbers of pre-frail and frail older adults with complex care needs.Can the Day Hospital model become a hub for the care of older adults across the spectrum of aging?This article explores its origins and traditional role in delivering Comprehensive Geriatric Assessment (CGA), assesses how it is currently being used to identify, triage and manage frailty, providing reablement, chronic disease management and anticipatory care planning, and discusses future models focused on the prevention, surveillance, and monitoring of frailty.It will examine how such approaches could increasingly deploy information communication technologies (ICT) using the Geriatric Day Hospital as a hub to maintain older adults in their home environment, to promote active aging, while both preventing and managing frailty.A consequence of population aging worldwide, but particularly in the European Union (1), is high rates of frailty (2) and multi-morbidity (3) among older people.This has directed health polices toward prevention and the pursuit of active and healthy aging (4, 5) but has nevertheless resulted in increasing numbers of older patients who could benefit from specialist geriatric services, meaning that limited resources must be stretched further.A fundamental challenge now faced in the management of older adults with multiple interacting medical and social problems is how to move from a single system, unidimensional construct to a more holistic and multidimensional model of care (6) that promotes preventative approaches and reablement as well as providing long-term management and rehabilitation.In this evolving environment, established ambulatory models of care for older people with complex needs that traditionally focused on the latter such as the Geriatric Day Hospital could be leveraged to find an additional purpose, to promote active and healthy aging and manage pre-frailty, while continuing to support the care of frail older adults.The Geriatric Day Hospital, which originated in the United Kingdom in the 1950s, is a dedicated outpatient service providing specialized, interdisciplinary, ambulatory, and usually rapid access geriatric medical, nursing, and rehabilitation care to community-dwelling older patients, whose primary strength is arguably the flexibility it offers (7).Day Hospitals represented an evolution in primary and secondary level ambulatory care models for older people with complex needs.Those attending Day Hospitals receive and benefit from CGA, individualized multi-domain assessment by a multidisciplinary team using validated scales and interventions that reduce adverse outcomes, hospital admission, and length of hospitalization (8).CGA is, however, labor intensive and economically costly; the Day Hospital rationalizes and targets this limited resource "under one roof " (9) in an effective (10) and cost-effective manner (11).A recent systematic review summarizing evidence from 16 studies comparing Geriatric Day Hospitals to non-integrated, non-comprehensive