Intended for healthcare professionals


Preventing admission of older people to hospital

BMJ 2013; 346 doi: (Published 20 May 2013) Cite this as: BMJ 2013;346:f3186
  1. Shaun D’Souza, specialist registrar, medicine for older people,
  2. Sunku Guptha, consultant physician, medicine for older people
  1. 1Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough PE3 9GZ, UK
  1. shaun.dsouza{at}

No evidence that managing “frail older” people in the community reduces admissions

The hypothesis that better community facilities for older people (over 65 years) will reduce demand for inpatient care is appealing and has gained wide acceptance. In England, many commissioning groups plan to redirect a substantial proportion of resources into services that will enable medical care for older people in the community. Secondary care trusts will need to take these funding changes into account when planning their services, and some trusts have already reduced their bed numbers and healthcare staff.

In July 2012, the then secretary of state for health in England, Andrew Lansley, first admitted that the shift of focus towards community healthcare, as outlined by the Health and Social Care Bill, would lead to a reduction in inpatient beds. Plans to reduce beds in medical wards, and in units dedicated to older people, rest on the assumption that longer term conditions can be safely treated in the community. Reducing emergency hospital admissions remains a key target, not only because of the high costs of emergency admission compared with other forms of care, but also because emergency admissions disrupt elective healthcare.1 But will better community services for older people really reduce acute admissions to hospital?

Recent substantial changes to the NHS have gone ahead despite a lack of evidence that any model of community care can greatly reduce hospital admissions in frail older people. In 2010 a paper commissioned by the …

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