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Keywords: old age, elderly, functional disability, foot problems, frailty, psychiatric morbidity Introduction Increases in the numbers and proportions of very elderly people (aged 75 and over) have been greater than [...]

This paper reports outcome data on mental and physical ability levels, mortality and accident rates, from a randomized controlled trial evaluating health authority funded nursing home and long-stay geriatric ward care in one inner London health district. There were no differences between settings in mortality rates, although respondents randomized to the nursing homes deteriorated more rapidly in overall, mental and functional ability levels. Previous analyses reported that they also experienced a higher accident rate that respondents in the wards. However, observational data from the evaluation clearly indicated that quality of life in the homes was superior to that in the wards. We conclude that the more rapid physical decline and greater risk of accident in the nursing homes have to be balanced against an inferior quality of life in the hospital, and that a judgement is not easy to make on behalf of other people.