Exploring emergency bed use by the elderly

Over the past 40 years, changes in medical and surgical treatment have driven reductions in average length of stay, a growth in the number of patients treated as day cases and a reduction in the overall number of acute beds. Recent Department of Health (DH) policy has encouraged a further shift in the focus of care from hospital to community settings. According to DH figures, the total number of acute beds has fallen by onethird in the past 25 years, from 181,000 in 1987/88 to 122,000 in 2009/10. Despite these reductions, there are still more than two million unplanned admissions every year for people aged 65 and over, which accounts for 68% of hospital emergency bed days. It has been estimated that 7,000 fewer emergency hospital beds would be needed by the NHS if all areas of England were able to achieve similar rates of admission and average length of stay for over 65s as those with the lowest use. According to a report from The King’s Fund – Older people and emergency bed use: exploring variation – there is an opportunity to reduce the number of overnight stays by 2.3 million per year and to reinvest the £462 m savings this would bring every year into community and primary care services. A reduction in emergency admissions for the over 65s would also be of benefit to this section of the population as emergency admission to hospital is a particularly disruptive and unsettling experience, for older people exposing them to new clinical and psychological risks and increasing their dependency.1-3 The rate of emergency bed use by the over 65s among Primary Care Trusts (PCTs) with the highest use is four times greater than PCTs with the lowest bed use. The report therefore looked at four groups of PCTs, including those with the highest and lowest bed use, to gain a better understanding of what might drive this wide variation in the use of hospital beds. The report acknowledged that the drivers affecting the variation in bed use are complex and that the links between bed use and access to community services such as GPs, community nursing and social care is not clear cut. However, some key drivers did emerge.

Geography – there is much lower emergency bed use in rural areas than urban ones – all of the PCTs with the lowest bed use are in rural settings and seven out of ten PCTs with the highest emergency bed use are in London.

Average age of local population – areas with a higher proportion of older people have lower rates of emergency bed use than areas with lower proportions, suggesting that these areas have prioritised the needs of older people and have better strategies in place to minimise admissions.