Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence

Abstract

Improving our understanding of the complex relationship between health and social care utilisation is vital as populations age. This systematic review aimed to synthesise evidence on the relationship between older adults’ use of social care and their healthcare utilisation. Ten databases were searched for international literature on social care (exposure), healthcare use (outcome) and older adults (population). Searches were carried out in October 2016, and updated May 2018. Studies were eligible if they were published after 2000 in a high income country, examined the relationship between use of social care and healthcare utilisation by older adults (aged ≥60 years), and controlled for an indicator of need. Study quality and bias were rated using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Study data were extracted and a narrative synthesis was conducted. Data were not suitable for quantitative synthesis. Thirteen studies were identified from 12,065 citations. Overall, the quality and volume of evidence was low. There was limited evidence to suggest that longer lengths of stay in care homes were associated with a lower risk of inpatient admissions. Residents of care homes with onsite nursing had fewer than expected admissions to hospital, compared to people in care homes without nursing, and adjusting for need. Evidence for other healthcare use outcomes was even more limited and heterogeneous, with notable gaps in primary care. We conclude that older adults’ use of care homes may moderate inpatient admissions. In particular, the presence of registered nurses in care homes may reduce the need to transfer residents to hospital. However, further evidence is needed to add weight to this conclusion. Future research should build on this evidence and address gaps regarding the influence of community based social care on older adults’ healthcare use. A greater focus on primary care outcomes is imperative.

A population-based retrospective cohort study of end-of-life emergency department visits by people with dementia: multilevel modelling of individual- and service-level factors using linked data

“…Associations between care home residence and reduced end-of-life ED attendance have been identified in the literature [ 6 ], but not variation by care home type. The potentially ‘protective’ effect of nursing homes has important policy implications and underlines the importance of timely clinical input in community care [ 34 ]. However, community care workforce capacity to support clinical continuity is tentative, with staff turnover in social care highest among registered nurses [ 35 ].…”

Complements or substitutes? Associations between volumes of care provided in the community and hospitals

“…We have identified no evidence specific to community care services, but the literature on social care services suggests community care services could be a weak substitute for hospital services. A systematic review of the association between social care and hospital care conducted by Spiers et al [ 21 ] found no evidence on the number of social care users and A&E attendances in the UK [ 22 ] and weak substitute relationships between users of care homes and hospital admissions [ 23 , 24 ] and A&E attendances in the USA [ 23 ]. However, a study by Forder [ 25 ] assessed the relationship between long term care and hospital utilisation for older patients, finding them to be substitutes, with a £1 spend on social care leading to a £0.35 reduction in hospital expenditure.…”

“…The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995 GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements.…”

Effects of public long-term care insurance on the medical service use by older people in South Korea

“…eligibility criteria and benefit package) in different countries (Bakx et al, 2015). Despite considerable evidence that formal care substitutes for informal care, only a few studies describe the association between public LTC and medical services (Gaughan et al, 2015;Spiers et al, 2019). Furthermore, such studies show mixed results that are not consistent (Spiers et al, 2019).…”