BMJ  2005;331:1271 (26 November), doi:10.1136/bmj.331.7527.1271-b

Letter

Transitional care for elderly people

Intermediate care can be safe and reduce hospital use, but is it and does it?

The first 150 words of the full text of this article appear below.

EDITOR—Crotty et al show that transitional, or intermediate, care facilities can be used to divert older people safely from hospital to a care home setting.¹ Our randomised controlled trial had similar findings,² but we could not exclude the possibility that such transitional care increases long term institutionalisation over a longer period of follow-up (12 months, compared with four months in the study by Crotty et al). Young et al's whole system study in Leeds showed that intermediate care services increased admissions to hospital.³ So, intermediate care can sometimes reduce hospital admission and sometimes it does not. It is not guaranteed to lead to outcomes that are equivalent to those of the services being replaced.

This inconsistency of the evidence base raises the question of whether findings obtained in controlled research studies of services can be generalised to other times and settings. If not, the fears previously raised about . . . [Full text of this article]

Queen's Medical Centre, Nottingham NG7 2UH
john.gladman@nottingham.ac.uk

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