Objective To examine the factors that predicted discharge destinations of all patients admitted to a combined geriatric medicine/old age psychiatry unit over a 4-year period. Method Data regarding discharge destinations, active medical problems and demographics of 234 patients admitted to the unit were analysed using non-parametric bivariate correlation and logistic regression analysis. Results Independence for activities of daily living (ADL) was the key predictor of discharge destination. In combination with the number of active medical problems and dementia severity, independence for activities of daily living (ADL) defined three distinct groups: patients discharged home, patients discharged to a nursing home and patients who died in hospital. Conclusions The findings suggest that although the key precipitants of admission to joint geriatric medicine/old age psychiatric care are behavioural and psychiatric, these factors are intercurrent, can be successfully treated in an appropriate environment, and do not play a major role in determining discharge outcome. These findings confirm the broad spectrum of need among older patients admitted to acute medical care identified in previous research and support the case for specialised joint provision to address their physical and mental health needs. Copyright (c) 2008 John Wiley & Sons, Ltd.