Frail Elderly: The Physiotherapist's Role in Preventing Hospital Admission

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Frailty

Costs

Length of stay and cost implications NHS

The latest published statistics which are being used in the literature relate to the years 2012 and 2013. Within this time frame 2,211,228 people over 60 were admitted to hospital in an emergency (DOH 2013b).

Graph 1 insert

Graph 2 insert

70% of day beds are occupied by people over 65; this is more than 51,000 beds at any one time. 85 year olds on average stay in hospital eight days longer than their younger counterparts (RCP 2012).

A table to show the cost of average stays in hospital
Type of stay	Short stay	Extra bed day	Visit to A and E
Cost	£1489	£273	£114
			(DOH 2013b)

Most emergency admissions to hospital happen through accident and emergency (DOH 2013b). On average a person over 85 spends 11 days in hospital (RCP 2012). If they pass through accident and emergency the total spent is approximately £3241 per patient, per visit.
However, More than a 25% of over 85 year olds stay for 2 weeks and 10% stay longer than a month, when admitted as an emergency (Cornwall et al. 2012). This means that even more money is spent.

Table 2 insert

410,377 elderly persons were admitted to hospital due to a fall in 2013. Appropriate strategies could prevent this by up to 30% (Age UK, 2015).

Length of stay and cost implications worldwide

Across the world there are varying amounts of elderly people in hospitals, how much time they spend in hospital and how much it costs.

Graph 3 insert

In terms of falls 59,046 males and 113,632 females were admitted to hospital following a fall in Australia in 2013-2014 (AHIW 2015).

Table 3 insert

92% of this care was paid for by insurance companies (Weiss and Elixhauser 2014).

Comparing this to the UK we can see that although most people stay in hospital for fewer days than in the USA, in the UK elderly people remain in hospital for longer. This may have negative health impacts. The UK is 16th in the world when it comes to average length of stay in hospital (health at a glance 2013).

Health and Social Care Integration

The Department of Health (2013b) report that although there are high numbers of emergency admissions through accident and emergency, which is very costly, at least one fifth could be dealt with in the community. Some ways of doing this are through: telemedicine, risk prediction tools, case management and alternatives to hospitals.
The integration of the health and social care systems in the UK was designed to improve service delivery and the effectiveness of care. There are nine outcomes which this incorporation is meant to achieve.

1. To allow people to look after and improve their own health
2. To allow as many people as possible to live independent lives
3. To ensure users have positive experiences of their health and social care
4. To maintain or improve users quality of life
5. To reduce health inequalities
6. To ensure unpaid carers are supported with their health and wellbeing needs
7. To ensure everyone; staff and users, are safe from harm at all times
8. To ensure staff employed in health and social care services feel involved in the work they do. They should also feel supported to implement change when needed.
9. To ensure that all resources are used effectively

The planning, resources and delivery of care will be now carried out together by the local authority or health board (The Scottish government 2015). This will mean that health and social care can run smoothly as one entity and users will experience a continuity of care.
One way this will have an effect is by reducing hospital admissions by allowing patient information to be shared more freely between hospitals and the community. This will allow for more effective multidisciplinary care in the community (Cornwall et al. 2012).
It has been said that better communication between health professionals, especially between those in hospitals and the social sector, may help reduce emergency admissions and help people return home sooner. However, there may be some barriers preventing this such as; differing funding levels, contrasting cultures, performance management and no sufficient way to share patient data. (DOH 2013b).

References

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