Letters Older people and hospitals

Finding alternatives to hospital for older people is not the answer

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f883 (Published 13 February 2013) Cite this as: BMJ 2013;346:f883
  1. Edmund J Dunstan, consultant geriatrician and physician1
  1. 1West Heath Hospital, Birmingham B38 8HR, UK
  1. Edmund.Dunstan{at}nhs.net

David Nicholson’s views on the use of hospitals by frail older people suggest disturbing ignorance.1 Frail older people, including those with dementia, may well benefit from diagnosis and treatment in hospital and are likely to need these because of their multiple diseases. A minority of admissions could be prevented by anticipatory care (especially for people with progressive conditions, such as dementia), hospital at home schemes, palliative care in nursing homes, or a greater acceptance of risk or rapid social care (where the social crisis is not a manifestation of acute illness)—but most cannot.

The problem is caused more by excess stay than inappropriate admission. In part, this is the hospitals’ fault, with disabling nursing regimens and a lack of interest in restoring function to enable people to return home. The expectation that future care should be arranged while patients are still in hospital, rather than be assessed for and arranged on discharge, contributes to such delays. Delays in social care, which the Care and Support Bill will do little to improve, add to the problem.

The Royal College of Physicians has called on hospitals to adapt to the needs of those most likely to need hospital care2: this will probably be a more productive approach than believing that alternatives to hospital care will solve the problem.


Cite this as: BMJ 2013;346:f883


  • Competing interests: None declared.