Long-term care spending and hospital use among the older population in England

Crawford, Rowena; Stoye, George; Zaranko, Ben

doi:10.1016/j.jhealeco.2021.102477

Cited by 30 publications

(21 citation statements)

References 18 publications

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“…This observation is consistent with suggestions that austerity measures in response to the 2008 recession and excess winter deaths such as the unusually high 2014/2015 winter deaths have adversely affected female mortality trends. Recent work by Crawford et al [10] examines the impact of social care cuts between 2009/2010 and 2017/2018 on the use of public hospitals in England and finds that reductions in long-term care spending have led to substantial increases in the number of emergency dept visits made by patients aged over 65: this is one element in a complex chain that links austerity measures to healthcare access and potentially poorer outcomes in terms of morbidity and mortality. The austerity hypothesis could also explain the larger impact on women because, on average, more women survive to older ages than men, and widowhood tends to leave them financially vulnerable to cuts in social welfare benefits (for references see [38,49,50]).…”

Section: Discussionmentioning

confidence: 99%

“…Average yearly mortality improvements in the UK over the calendar time period 2011-2017 (Expected vs Observed)This comment applies to each gender overall (age 50-95) as well as to all of the constituent age-subgroups shown (except for the APC model at ages 50-64 for women and the LC model at ages 80-95 for men).Tables 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26 and 27 in the Appendix provide the detailed results corresponding to Table…”

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confidence: 99%

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The slowdown in mortality improvement rates 2011–2017: a multi-country analysis

et al. 2022

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Mortality rates have been falling or ‘improving’ in many demographically developed countries since the 1950s. However, there has been a slowdown since 2010 in the speed of improvement and this phenomenon has been particularly marked at ages over 50. To understand better this mortality slowdown, we have analysed long-run mortality trends of a group of developed countries using data up to 2017 from the Human Mortality Database. Specifically, we have used statistical models to parametrise the historical mortality trends of 21 countries between 1965 and 2010 and then forecast trends beyond 2011. We find that many countries have experienced lower mortality improvement rates in 2011–2017 than in the previous decade and also experienced lower improvement rates in 2011–2017 than would have been forecast based on the models fitted to data prior to 2011. Some of the Scandinavian populations have bucked the stalling mortality improvement trend, experiencing higher mortality improvement rates than the forecasts. We conclude that part of the slowdown in mortality improvement rates of the over 1950s since 2011 would have been expected from historical trends in many countries, especially among men. However, there has been a notable slowdown since 2011, compared with the model forecasts, in many countries especially among women. A few countries had higher mortality improvement rates than forecast. A better understanding of the drivers behind these complex trends would help decision makers in insurance companies and pension funds and also inform public policy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The slowdown in mortality improvement rates 2011–2017: a multi-country analysis

et al. 2022

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“…These factors may mean that community services have less capacity to identify unmet domiciliary Open access care needs, and these needs are more likely to be identified by acute hospital services. 18 Due to the relatively short follow-up in our study (2 years), we were not able to test changes in the association between hospital admission and domiciliary care over time. We anticipate that the challenging funding environment may have strengthened this relationship.…”

Section: Implications For Policy and Practicementioning

confidence: 91%

Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England

Grimm

Lewer

Craig³

et al. 2022

BMJ Open

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Objective Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. Design Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. Setting London Borough of Barking and Dagenham, England. Participants Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). Outcome measures The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. Results 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. Conclusion Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers.

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“…The growing number of the elderly requires the reformation of Asian health systems to meet the needs of older people [32]. Long-term care policies have become critical for governments, as countries are faced with societal changes due to the growing population share of the elderly, implying a significant need for long-term care (LTC) [73]. There are a lot of unmet elderly care needs across the Asian region, highlighting the need for family, community, and government efforts to achieve long-term care for the fast-growing ageing population [74].…”

Section: Elderly Care In the Asian Regionmentioning

confidence: 99%

The Sustainable Care Model for an Ageing Population in Vietnam: Evidence from a Systematic Review

2022

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Social demographic studies in Vietnam have shown a growing trend of an ageing population. Demographic trends project that one third of the Vietnamese population will be aged 65 years and older by 2050. Vietnam is a country where the majority of the elderly live with their children, with little savings and pension. The purpose of this review was to explore existing literature on models of care for an ageing population and provide evidence to develop a care model that is suitable for the ageing community in Vietnam. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was carried out. An extensive literature search was performed, with a focus on articles and other materials with relevance to elderly care in Vietnam in terms of socio-economic, demographic, and associated factors based on comprehensive data sources. The review found that there is a lack of evidence of professional practice for caring for the aged in Vietnam. There also is a lack of evidence of government support for the limited community initiatives to support the ageing. There exist no community models of care for the ageing population in Vietnam. From a global perspective, there exist alternative models of care options to support the elderly through various care models, such as living in assisted-care facilities, home care, and other assistance. Inter-professional practice care models and health services were found to be essential for an ageing population. There is limited literature specifically for the care of an ageing population in Vietnam. Most of the available literature on care models for the aged is drawn from developed countries. The review offers insights into the development of care models for the elderly in Vietnam, with the need for inter-professional efforts in practice settings to support the ageing Vietnamese population. The reviewed literature agrees on the developing global challenges due to ageing. Despite the existing literature on care models for the ageing, there is a lack evidence-based care models concerning the current and future needs of elderly care in middle- and lower-income economies like Vietnam. More evidence is required to establish evidence for best care models for the elderly in developing economies.

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Long-term care spending and hospital use among the older population in England

Cited by 30 publications

References 18 publications

The slowdown in mortality improvement rates 2011–2017: a multi-country analysis

The slowdown in mortality improvement rates 2011–2017: a multi-country analysis

Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England

The Sustainable Care Model for an Ageing Population in Vietnam: Evidence from a Systematic Review

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