Why are some elderly and frail patients able to cope at home while others are becoming increasingly dependent on hospital care?

With increasing pressures on the NHS, experts at the University of Sunderland have been carrying out vital research with patients in Northumberland which could prove a lifeline to the UK’s health service.

Despite the announcement this week that the government is to increase NHS England’s current £114bn budget by an average of 3.4% in each of the next five years, there are still concerns over the growing problem of supporting an ageing population.

The number of over-65s living in the UK is expected to increase by 1.1million between 2015 and 2020. With an increasing population of older people with complex needs and high healthcare requirements, the NHS is under severe pressure to optimise care – while keeping costs down.Unplanned admissions to hospital are distressing and disruptive for patients, carers and families.

Many unplanned admissions are for patients who are elderly, infirm or have complex physical or mental health and care needs which put them at high risk of admission or re-admission to hospital.

While an increase in funding to the NHS is welcome, experts claim there need to be a realignment of funding to incentivise keeping patients, particularly the frail and elderly, out of hospital or in hospital for the minimum time required.

Now, Dr Rosie Dew and Professor Scott Wilkes from the University of Sunderland have taken a unique approach to addressing the problem.

Dr Dew said: “Instead of researching patients who were being admitted to hospital, we instead focused on those who were able to remain at home. This posed the question – why are certain high-risk patients able to avoid hospital care, while others are repeatedly readmitted?”

Working with Northumberland Clinical Commissioning Group, Dr Dew identified 15 GP surgeries in the county willing to take part in the study, with 30 participants interviewed by the university’s researchers.

She said: “In the end, we discovered there was no one solution, instead a number of factors which combined to play an important role in reducing hospital admissions.”

Key reasons why elderly and frail patients avoided hospital admissions were:

  • Coping strategies: Patients who managed to avoid unplanned visits to hospital talked about coping because they “accepted” their condition. They were accepting that there were things they could no longer do due to their age and health situation. Positive thinking also played a key role in avoiding hospital admission, while those who were more anxious reported multiple re-admissions.
  • Support networks: A strong support network was also a key factor in helping patients cope with their health conditions. From having family/friends to check on them to carers visiting their homes. Spouses were also found to play a key role in helping relieve anxiety.
  • Having confidence in medical professionals: Most patients recounted trying to see the same GP each time. They felt this built a good patient-doctor relationship, developed trust and made them feel the medical professional had a good understanding of their health needs.
  • Decision making: Patients making decisions about their healthcare alongside their GP proved popular. Agreeing on an approach treatment helped patients in their overall wellbeing.
  • Medication and physical aids: Preventative medication and daily living aids, such as adapted chairs, shower and bath aids, bedside trolleys, walkers and alarms helped patients manage at home.

The research concluded that while vital factors, like medicines, daily living aids and a strong support network were vital in helping patients cope in their own homes, positive thinking and acceptance of limitations were also key factors.

Dr Dew said: “These findings show insights into the attitudes of high risk patients towards their health and a deeper understanding of the behavioural aspects that contribute to them avoiding unplanned hospital admissions.”

The need for better coping mechanisms among the elderly is expected to remain high in the years to come with Figures obtained by the Local Government Association this year suggesting that by the end of the decade the number of hospital admissions due to an older person falling is set to rise to nearly 1,000 a day.

The ageing population is a major factor in the problems currently facing the health service, and it’s one that all health systems in the world are struggling with. Medical advances have meant that people are living longer. When the NHS was created, life expectancy was 13 years shorter than it is now.

Every month the NHS sees one million patients and with 1.7million staff it’s the fifth biggest employer in the world.