Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia
Stephanie L. Harrison A B * , Catherine Lang A , Tesfahun C. Eshetie A B C , Maria Crotty D E , Craig Whitehead D E , Keith Evans A , Megan Corlis F , Steve Wesselingh A G , Gillian E. Caughey A B and Maria C. Inacio A BA
B
C
D
E
F
G
Abstract
The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019.
A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated.
The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals).
While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.
Keywords: aged care, emergency department presentations, home care, hospitalisations, long-term care, observational research, older adults, residential aged care.
References
1 Australian Institute of Health and Welfare. Admitted patients. 2022. Available at https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients
2 Szilcz M, Wastesson JW, Johnell K, Morin L. Unplanned hospitalisations in older people: illness trajectories in the last year of life. BMJ Supportive & Palliative Care 2021; bmjspcare-2020-002778.
| Crossref | Google Scholar | PubMed |
3 Walsh B, Roberts HC, Nicholls PG. Features and outcomes of unplanned hospital admissions of older people due to ill-defined (R-coded) conditions: Retrospective analysis of hospital admissions data in England. BMC Geriatrics 2011; 11(1): 62.
| Crossref | Google Scholar | PubMed |
4 Chen Y, Almirall‐Sánchez A, Mockler D, Adrion E, Domínguez‐Vivero C, Romero‐Ortuño R. Hospital-associated deconditioning: Not only physical, but also cognitive. Int J Geriatr Psychiatry 2022; 37(3): 1-13.
| Crossref | Google Scholar |
5 Davies LW, Air T, Jorissen RN, Mittinty MN, Caughey G, Wesselingh S, et al. Historical Trends and Future Projections of Demand for Permanent Residential Aged Care for Older People in Australia, 2008–2052. J Am Med Dir Assoc 2023; 25: 252-258.e8.
| Crossref | Google Scholar | PubMed |
6 Australian Institute of Health and Welfare. Older Australians Demographic Profile. 2023. Available at https://www.aihw.gov.au/reports/older-people/older-australians/contents/demographic-profile
7 Australian Bureau of Statistics. Population Projections, Australia. 2018. Available at https://www.abs.gov.au/statistics/people/population/population-projections-australia/latest-release
8 Australian Government Department of Health and Aged Care. 2022–23 Report on the Operation of the Aged Care Act 1997. 2023. Available at https://www.health.gov.au/resources/publications/2022-23-report-on-the-operation-of-the-aged-care-act-1997?language=en
9 Wiles JL, Leibing A, Guberman N, Reeve J, Allen RE. The meaning of “aging in place” to older people. Gerontologist 2012; 52(3): 357-66.
| Crossref | Google Scholar | PubMed |
10 Australian Institute of Health and Welfare. Transitions to residential aged care after hospital for people living with dementia. 2023. Available at https://www.aihw.gov.au/reports/dementia/transitions-to-aged-care-after-hospital-dementia/contents/summary
11 Thapaliya K, Cornell V, Lang C, Caughey GE, Barker A, Evans K, et al. Aged and Health Care Service Utilization by Older Australians Receiving Home Care Packages. J Am Med Dir Assoc 24(3): 395-39.e2.
| Crossref | Google Scholar |
12 Royal Commission into Aged Care Quality and Safety. Hopsitalisations in Australian Aged Care: 2014/15–2018/19. 2021. Available at https://nla.gov.au/nla.obj-2924408762/view
13 Government of South Australia SA Health. Ambulance waiting times. 2023. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/our+performance/ambulance+waiting+times
14 Inacio MC, Jorissen RN, Khadka J, Whitehead C, Maddison J, Bourke A, et al. Predictors of short-term hospitalization and emergency department presentations in aged care. J Am Geriatr Soc 2021; 69(11): 3142-56.
| Crossref | Google Scholar | PubMed |
15 Inacio MC, Caughey GE, Wesselingh S, on behalf of the ROSA Research Team & Steering. Registry of Senior Australians (ROSA): integrating cross-sectoral information to evaluate quality and safety of care provided to older people. BMJ Open 2022; 12(11): e066390.
| Crossref | Google Scholar | PubMed |
16 Inacio MC, Lang C, Bray SCE, Visvanathan R, Whitehead C, Griffith EC, et al. Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort. Intern Med J 2021; 51(5): 712-24.
| Crossref | Google Scholar | PubMed |
17 Australian Institute of Health and Welfare. National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations. 2022. Available at https://meteor.aihw.gov.au/content/740851
18 Engel L, Hwang K, Panayiotou A, Watts JJ, Mihalopoulos C, Temple J, et al. Identifying patterns of potentially preventable hospitalisations in people living with dementia. BMC Health Serv Res 2022; 22(1): 794.
| Crossref | Google Scholar | PubMed |
19 Australian Institute of Health and Welfare. Disparities in potentially preventable hospitalisations across Australia, 2012–13 to 2017–18. Canberra; 2020. Available at https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/contents/about
20 Australian Medical Association. Putting health care back into aged care. 2021. Available at https://www.ama.com.au/articles/report-putting-health-care-back-aged-care-0
21 Australian Institute of Health and Welfare. Emergency department care 2019-20. 2020. Available at https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care
22 Long SJ, Brown KF, Ames D, Vincent C. What is known about adverse events in older medical hospital inpatients? A systematic review of the literature. Int J Qual Health Care 2013; 25(5): 542-54.
| Crossref | Google Scholar | PubMed |
23 Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J. A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 2014; 43(6): 759-66.
| Crossref | Google Scholar | PubMed |
24 Dickins M, Joe A, Lowthian JA. Ten-Year Trends and Predictors of Unplanned Hospitalisation in Community-Dwelling Older People Receiving Home-Based Care. Health & Social Care Comm 2023; 2023: 9332777.
| Crossref | Google Scholar |
25 Inacio MC, Jorissen RN, Wesselingh S, Sluggett JK, Whitehead C, Maddison J, et al. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ Open 2021; 11(11): e057247.
| Crossref | Google Scholar | PubMed |
26 Marincowitz C, Preston L, Cantrell A, Tonkins M, Sabir L, Mason S. Factors associated with increased Emergency Department transfer in older long-term care residents: a systematic review. Lancet Healthy Longev 2022; 3(6): e437-47.
| Crossref | Google Scholar | PubMed |
27 Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, et al. Effects of an Intervention to Reduce Hospitalizations From Nursing Homes: A Randomized Implementation Trial of the INTERACT Program. JAMA Internal Med 2017; 177(9): 1257-64.
| Crossref | Google Scholar | PubMed |
28 Giebel C, Harvey D, Akpan A, Chamberlain P. Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP). BMC Health Serv Res 2020; 20(1): 94.
| Crossref | Google Scholar | PubMed |
29 Ouslander J. Strategies to reduce potentially avoidable hospitalisations among long-term care facility residents. BMJ Qual Safety 2019; 28(7): 515-9.
| Crossref | Google Scholar | PubMed |
30 Fan L, Hou XY, Zhao J, Sun J, Dingle K, Purtill R, et al. Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study. BMC Health Serv Res 2016; 16: 46.
| Crossref | Google Scholar | PubMed |
31 Searle B, Barker RO, Stow D, Spiers GF, Pearson F, Hanratty B. Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. BMJ Open 2023; 13(2): e064914.
| Crossref | Google Scholar | PubMed |
32 Tappen RM, Wolf DG, Rahemi Z, Engstrom G, Rojido C, Shutes JM, et al. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program. Health Care Manag 2017; 36(3): 219-30.
| Crossref | Google Scholar | PubMed |
33 Australian Institute of Health and Welfare. Injury in Australia. 2023. Available at https://www.aihw.gov.au/reports/injury/injury-in-australia/contents/introduction
34 Inacio MC, Moldovan M, Whitehead C, Sluggett JK, Crotty M, Corlis M, et al. The risk of fall-related hospitalisations at entry into permanent residential aged care. BMC Geriatrics 2021; 21(1): 686.
| Crossref | Google Scholar | PubMed |
35 Dyer SM, Suen J, Kwok WS, Dawson R, McLennan C, Cameron ID, et al. Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses. Age Ageing 2023; 52(12): afad217.
| Crossref | Google Scholar | PubMed |
36 Suen J, Kneale D, Sutcliffe K, Kwok W, Cameron ID, Crotty M, et al. Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis. Age Ageing 2023; 52(11): afad185.
| Crossref | Google Scholar | PubMed |
37 Huntley AL, Chalder M, Shaw ARG, Hollingworth W, Metcalfe C, Benger JR, et al. A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission. BMJ Open 2017; 7(7): e016236.
| Crossref | Google Scholar | PubMed |
38 Greene L, Lane R, Crotty M, Whitehead C, Potter E, Bierer P, et al. Evaluating a new emergency department avoidance service for older people: patient and relative experiences. Emerg Med J 2023; 40(9): 641-5.
| Crossref | Google Scholar | PubMed |
40 Australian Government Department of Health and Aged Care. Increasing Choice in Home Care. Canberra: Department of Health and Aged Care; 2017. Available at https://webarchive.nla.gov.au/awa/20190208044558/https://agedcare.health.gov.au/increasing-choice-in-home-care [updated February 2019].
41 Australian Government Department of Health and Aged Care. Aged Care Reform Roadmap. 2023. Available at https://www.health.gov.au/our-work/aged-care-reforms/roadmap
42 Australian Bureau of Statistics. Hospital output measures in the Australian National Accounts: experimental estimates, 2004–05 to 2017–18. 2020. Available at https://www.abs.gov.au/statistics/research/hospital-output-measures-australian-national-accounts-experimental-estimates-2004-05-2017-18
43 KPMG. Aged Care Market Analysis. 2022. Available at https://kpmg.com/au/en/home/insights/2022/09/aged-care-market-analysis.html
