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LETTERS: Gerard Bulger Intermediate care is ageist BMJ 2002; 325: 495 [Full text]

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Intermediate care

Michael K Harkness   (3 September 2002)

Intermediate care 3 September 2002
Michael K Harkness, Specialist Registrar, Geriatric / General Internal Medicine Dewsbury and District Hospital, WF13 4HS Send response to journal: Re: Intermediate care	EDITOR - Bulger raises a number of points that I agree with entirely.Hospital does remain the safest place to obtain rapid assessment AND access to diagnostic tests.With only a few simple baseline tests an initial working diagnosis is usually apparent and a decision regarding the need for admission can be made.If admission is not required a period of care outside the patients home or extra care within the home may be required. In contrast, I have had concerns at the number of patients who have been admitted in recent months who have spent a period of up to two weeks in "flagship" beds.In my experience, it appears that these patients have often presented with non specific symptoms,have not had access to routine baseline tests and therefore a daignosis has not been made. It may well be that this seemingly small group reflect the tip of the iceberg for a much wider problem.Unfortunately there is no data on how many older people are admitted to these services and rehabilitate fully without requiring any further interventions. Clearly this requires further evaluation and clarification to ensure that a potentially significant number of older people do not receive the "lo tech" services that Bulger describes.