Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data

doi:10.1136/bmj.330.7486.289

BMJ 2005;330:289-292 (5 February), doi:10.1136/bmj.330.7486.289

Primary care

Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data

Martin Roland, director¹, Mark Dusheiko, research fellow², Hugh Gravelle, professor of economics², Stuart Parker, professor of health care for older people³

¹ National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ² National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO1 5DD, ³ Sheffield Institute for Studies of Ageing, University of Sheffield, Sheffield S5 7AU

Correspondence to: M Roland m.roland{at}man.ac.uk

Objective To determine the subsequent pattern of emergency admissionsin older people with a history of frequent emergency admissions.

Design Analysis of routine admissions data from NHS hospitalsusing hospital episode statistics (HES) in England.

Subjects Individual patients aged $≥$ 65, $≥$ 75, and $≥$ 85 who hadat least two emergency admissions in 1997-8.

Main outcome measures Emergency admissions and bed use in this"high risk" cohort of patients were counted for the next fiveyears and compared with the general population of the same age.No account was taken of mortality as the analysis was designedto estimate the future use of beds in this high risk cohort.

Results Over four to five years, admission rates and bed usein the high risk cohorts fell to the mean rate for older people.Although patients $≥$ 65 with two or more such admissions wereresponsible for 38% of admissions in the index year, they wereresponsible for fewer than 10% of admissions in the followingyear and just over 3% five years later.

Conclusion Patients with multiple emergency admissions are oftenidentified as a high risk group for subsequent admission andsubstantial claims are made for interventions designed to avoidemergency admission in such patients. Simply monitoring admissionrates cannot assess interventions designed to reduce admissionamong frail older people as rates fall without any intervention.Comparison with a matched control group is necessary. Widerbenefits than reduced admissions should be considered when introducingintensive case management of older people.

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