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Big Rise in Elderly Repeat Patients Hits NHS Pressure on Hospital Beds

Posted on: Monday, 26 December 2005, 09:00 CST

By HELEN PUTTICK

THE number of elderly "revolving door patients", those repeatedly admitted to hospital, has increased by more than a quarter in a decade.

The findings by Scotland's health service watchdog have raised fears that many pensioners are being ejected from hospital beds before proper measures have been put in place to look after them in the community.

The report also found those who were discharged from wards only to be readmitted within a year tended to have been sent home earlier than patients who subsequently did not require more in-patient treatment.

Liz Duncan, of Help the Aged in Scotland, said: "There does seem to be, for all categories of patients, as fast as possible turnaround from hospital treatment to going home.

Sometimes for older people in particular it is a difficult situation, because if the home support is not absolutely in place and if they are not completely well, they could have a relapse at home.

"You can have this kind of revolving door of admissions if all the conditions, including home support, are not correctly in place."

The report, compiled by NHS Quality Improvement Scotland, revealed the number of pensioners discharged from hospital only to be readmitted within a year has increased by 26per cent since 1994- 5.

The study discards poorer health as an explanation for the problem, but points to a shortage of long-stay hospital beds and care homes as well as the increased isolation of frail older people in their own homes due to dwindling family networks.

The report said a rise in emergency admissions was increasingly putting pressure on the system. It highlighted that over-65s accounted for 40per cent of those suddenly needing beds.

The proportion of over-65s admitted to hospital twice or more in a year has risen from 354 per 10,000 in 1994-5 to 447 per 10,000 in 2003-4. Among the over-85s, the increase is even more marked, with the rate of men experiencing multiple admissions growing from 853 per 10,000 in 1994-5 to 1058 per 10,000 in 2003-4.

Pensioners now have shorter spells in hospital on average than they did a decade ago, according to the study. However, the investigators found that over-85s who did not need to be readmitted to hospital within a year had been kept in around four days longer, on average, than those who reappeared on wards.

The average spell in hospital for men who experienced multiple emergency admissions was 16.2 days compared to 21.2 days for men admitted just once during 2003-4.

Joe Campbell, chairman of Scottish Care, which represents independent care home owners, said the problem came down to money. "If older patients are being put out of hospitals quicker than they should because of the backlog of routine operations which need performing, they have got to have care . . . But the big problem is if they require care they need to get it either from the council or independent care-at-home suppliers. Where is the money for that? There is no money."

Dr David Stewart, consultant in geriatric medicine in Glasgow and deputy secretary of the British Geriatrics Society in Scotland, said: "Really the question is what percentage of these people came back for completely unpreventable reasons. The answer is, we do not know. There is a percentage where we could perhaps have done a bit better."

The Scottish Executive has set a target to reduce multiple admissions among the elderly by more than 20per cent by April 2009.

Source: Herald, The; Glasgow (UK)

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