Beales and Tulloch's arguments about anticipatory care of older patients 1 represent the triumph of hope over experience. Anticipatory care for older people in the community has not yet been shown to be clinically or cost-effective in a thorough and less selective overview of the literature. 2 Trials of anticipatory care for older people in US, UK, and Denmark up to 1990 showed a rise in patients' morale, increased referrals to all agencies, reduced duration of in-patient stay (sometimes), increased in-patient rates (mostly respite care), reduction in mortality in some trials, but no improvement in functional ability and an increase in GP workload unless alternative services were provided. 3 Evidence for the benefits of anticipatory care remains scarce. The UK MRC trial showed little or no benefits for quality of life or health outcomes for older people receiving comprehensive assessment. 4 A systematic review of 15 trials of preventive home visits for older people showed no clear evidence of benefit 5 while the ProAge trial yielded no change in health-risk behaviours in older people. 6 Case management has not reduced hospital admission rates for frail older people and may even cause disruption of established nursing teams and services. There are signs that effective interventions are being developed but effect sizes in positive trials are often small and may not remain when interventions are transferred to routine practice. GPs should be cautious about committing time and resources to forms of anticipatory care for older patients that are plausible but untested.
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