Defining the characteristics of intermediate care models including transitional care: an international Delphi study.

BACKGROUND: Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. AIM: To identify and define the characteristics of intermediate care models. METHODS: A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. RESULTS: Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. DISCUSSION: There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. CONCLUSIONS: This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.

A pagetic elderly lady with back pain.

An elderly lady suffering from Paget's disease presented with severe back pain after sustaining a fall. The rise in inflammatory markers and poor response to analgesics led to the diagnosis of septic discitis [corrected] that was confirmed by MRI. A high index of suspicion for septic discitis [corrected] is necessary in elderly patients presenting with back pain and an associated rise in inflammatory markers.

Do not underestimate your patient's back pain.

Back pain is a common complaint in the elderly population which is often attributed to osteoarthritis or vertebral collapse secondary to osteoporosis. The following case reports describe an easily-missed cause of back pain which is becoming increasingly important and thus should be actively sought.