Improving outcomes for older people remains a national priority in Scotland. Growing numbers of frail older people are admitted to hospital as an emergency and some of those admitted will deteriorate further or experience a delay in returning home, or are assessed, often prematurely, by hospital clinicians as unable to return home.
- Analysis of resource use in the year 2012/13 identified that 36,632 of the highest resource users in Scotland that were aged 75+ accounted for 2.3m inpatient bed days
- 75% of beds occupied through delayed discharge are by those aged 75+
- The number of emergency bed days used by over 75s has decreased, however the number of admissions has increased from 135,907 in 2009/10 to 148,937 in 2013/14
- Unscheduled care costs NHSScotland £1.5bn per year
- Evaluation estimated that falls alone cost NHSScotland £471m per year
- Falls account for 390,000 emergency bed days a year
Health and social care services and their partners working to address the challenge of an ageing population and rising demands on public services, falls among older people are a major and growing concern.
Analysis of data and evidence has shown that with increasing age comes an increased risk of episodic emergency hospital admission. People aged 75 years and over in Scotland are 7 times more likely to experience an unplanned admission per 1,000 of the population compared to those aged between 16-24, and those aged 80 years and over have accounted for almost all of the increase in emergency bed days between 1981 and 2001 in Scotland.
The LWiC team initially reviewed different tools that could be used to identify people with frailty, which we compared in our frailty screening and assessment tools comparator. The team then worked with nine GP practices to test the electronic frailty index to identify people at risk of frailty in the community. The frailty and falls assessment and intervention tool was developed through Plan-Do-Study-Act cycles with a GP practice in Glasgow to provide structure to multi-disciplinary team meetings and help health and care professionals to signpost individuals to appropriate community-based support.
HSCPs were also supported with improvement activity around falls risk and falls reduction, and the LWiC team worked closely with the Active and Independent Living Improvement Programme and the Scottish Ambulance Service on community falls pathways.
LWiC has now completed its planned programme of work for frailty and falls, and is now moving to work with geographical areas with a greater focus on regional spread.
Regional work has now started with Living Well in the North, which is spreading the frailty work and the electronic frailty index across the ten Health and Social Care Partnerships in the North of Scotland. The collaborative aims to improve early identification of people with frailty, and to develop evidence-based targeted approaches to improve their outcomes.
NHS boards and Health and Social Care Partnerships.
Benefits of programme
Examples of effective falls management and prevention range from increasing awareness of falls prevention activities for those that work with older people, identifying individuals at risk, and developing linked pathways to ensure that older people are not taken to Accident & Emergency unnecessarily.
Evidence suggests that people with frailty benefit from early interventions to reduce the likelihood of them requiring emergency hospital attention. These interventions include a focus on clinical pathways, exercise and access to multi-disciplinary teams to ensure early and effective discharge from hospital.
Evidence indicates that integrated urgent care pathways for falls and frailty that focus on triage, assessment, and management increase the likelihood of people remaining in the community.