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Who gets admitted and who is sent home? A register-based study of older people’s care trajectories through hospital emergency departments

2018 Conference Presentation

Care integration Sweden

12 September 2018

Who gets admitted and who is sent home? A register-based study of older people’s care trajectories through hospital emergency departments

Pär Schön, Aging Research Center; Karolinska Institutet, Sweden

Janne Agerholm, Karolinska Institutet & Stockholm University and Center for Epidemiology and Community Medicine, Stockholm County Council, Sweden
Lennarth Johansson, Stockholm Gerontology Research Center, Sweden
Bo Burström, Center for Epidemiology and Community Medicine, Stockholm County Council and Department of Public Health Sciences, Karolinska Institutet, Sweden
Pär Schön, Karolinska Institutet & Stockholm University, Sweden


Background and objectives: For decades, Swedish policy and practice regarding care of older people have been guided by the goal of ‘age in place’. This has led to a drastic downsizing of institutional resources. The number of hospital beds has been reduced by more than 50 percent, which has led to shorter length of hospital stays. Since year 2000, a third of the beds in municipal institutional care have disappeared, and an increasing number of frail older people with complex health problems and cognitive impairments are now dependent on help in their own homes. These changes have increased the pressure on primary care and home help services, with an increased risk for an unsustainable home situation and an increase in the number in emergency department (ED) visits. The aim of this study is to investigate care trajectories through the EDs into either hospital based care or return to the home and the risk of returning to emergency wards.

Data and methods: This is a cross-sectional study using register-based administrative data on utilization of care from the Stockholm County Councils administrative data base for analyses and follow-up of health care utilization. The study population consisted of all the individuals aged 65 years or above visiting any of hospital based emergency wards in the Stockholm County during 2015 (N=101,071).

Results: Our preliminary analysis showed that 28 percent of all ED visits in 2015 were made by people 65 years and older. Older people sought ED care to a higher extent due to non-specific causes compared to younger people. Almost half of those 65+ who sought ED care were admitted to inpatient care; among those 80+ six out of ten were admitted. The length of stay in inpatient care was, on average, 10 days. After the hospital stay, most patients returned to their own homes, often in a poor condition. 9 percent of those who had been admitted to inpatient care were readmitted within 10 days, and 19 percent within 30 days. This also meant that a large proportion (53%) of older people’s ED visits did not result in an admission to inpatient care. A large proportion of those who were not admitted returned to the ED; 15 percent made a new visit within 10 days and 24 percent within 30 days.

Policy implications and conclusions: Older people represented a large population in the EDs. Those who sought ED care and were not admitted to inpatient care seems to be a particularly vulnerable group. The situation for many of those returning home is often characterised by a poor and unstable health status. This means, that there are remaining care needs for the group that is sent home directly after ED, and that their needs should be followed up systematically. Measures such as ‘safe return programmes’ will be discussed.