Factors Associated with Unplanned Admission to Hospital: A National Time-To-Event Analysis of Over 65s In Scotland

Abstract

IntroductionMany high-income countries are reorganising and integrating health and social care (long-term care) services. However, little evidence exists showing how these services interact. Demographic changes and austerity measures have led to increased demand for social care services at the same time as the availability of formal and informal services has declined. The aim of this study was to identify risks for unplanned hospital admission taking account of social care receipt, multimorbidity and sociodemographic status.
 Objectives and ApproachThis retrospective, observational study included all individuals over the age of 65 in Scotland in financial year (Apr-March) 2015/16 (n = 879,027). The main outcome was time to first unplanned hospital admission. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors for unplanned admission. Explanatory variables included: receipt of social care, multimorbidity, socioeconomicposition, age, and sex.
 ResultsMultivariate analysis showed that, after adjusting for: age, sex, multimorbidity, socioeconomic position, and any past unplanned admissions, receipt of social care was associated with a two-fold increased risk of having an unplanned admission compared to those without care (HR 1.98 95%CI 1.95-2.00). Increasing age, severity of multimorbidity, and lower socioeconomic position were also all associated with increasing risks of unplanned admission.
 Conclusion / ImplicationsOur results show those in current receipt of social care are also more likely to use unplanned hospital care compared with those that do not receive care. Current provision of social care services is unlikely to lead to reductions in unplanned hospital admission.