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

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

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

Subjects: Individual patients aged greater than or equal to 65, greater than or equal to 75, and greater than or equal to 85 who had at 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 five years and compared with the general population of the same age. No account was taken of mortality as the analysis was designed to estimate the future use of beds in this high risk cohort.

Results: Over four to five years, admission rates and bed use in the high risk cohorts fell to the mean rate for older people. Although patients greater than or equal to 65 with two or more such admissions were responsible for 38% of admissions in the index year, they were responsible for fewer than 10% of admissions' in the following year and just over 3% five years later.

Conclusion: Patients with multiple emergency admissions are often identified as a high risk group for subsequent admission and substantial claims are made for interventions designed to avoid emergency admission in such patients. Simply monitoring admission rates cannot assess interventions designed to reduce admission among frail older people as rates fall without any intervention. Comparison with a matched control group is necessary. Wider benefits than reduced admissions should be considered when introducing intensive case management of older people.