Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.

I Farag,C Vogler,C M Dean,K Howard,M L Ferreira,C Sherrington,J C T Close,S R Lord,S O’Rourke,R G Cumming

doi:10.1186/s12877-016-0254-x

Abstract

BackgroundAdmission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage.MethodThe present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups.Results33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories.ConclusionThere appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs.Trial registrationAustralian and New Zealand Clinical Trial Registry ACTRN12607000563460>TrialSearch.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0254-x) contains supplementary material, which is available to authorized users.

Highlights

Admission to hospital can lead to persistent deterioration in physical functioning, for the more vulnerable older population
No significant impact of a home-based exercise program was evident on service use or costs
As a result of the impact of hospitalisation on physical functioning older people who have recently been discharged from hospital may be high users of health and social support services, but this is yet to be well investigated

Summary

Introduction

Admission to hospital can lead to persistent deterioration in physical functioning, for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be high users of health and social support services. As a result of the impact of hospitalisation on physical functioning older people who have recently been discharged from hospital may be high users of health and social support services, but this is yet to be well investigated. The recent focus on early discharge from hospital [9] may have shifted costs from the acute setting to the community [10]; emphasizing the increasing importance of consideration of social support costs in planning and modelling

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