Reducing hospitalisations for older Australians

One in five South Australians will experience an unplanned hospitalisation or emergency department presentation within 90 days of undertaking an aged-care assessment, according to new research by the University of South Australia and the South Australian Health and Medical Research Institute.

The large-scale study, which analysed the outcomes of 22,130 people who had an aged-care eligibility assessment (ACAT), also found 25 predictors that identify older people most at risk of being hospitalised. Risk factors include level of frailty, types of medications taken and frequency of after-hours services use.

The findings suggest that ACAT, which 186,000 Australians undertake every year, is a promising period to implement programs targeted at reducing hospitalisation for older Australians, said lead researcher Professor Maria Inacio.

“We can identify moderately well those most at risk of being hospitalised, meaning we can determine the older people who need the most follow-up after their assessment,” Professor Inacio said.

“If we provide targeted treatment or therapies during this time, we can not only provide better support to older people transitioning to care, but we could reduce overcrowding and ramping in our hospitals as well.

In 2018 in Australia, older people accounted for 16% of the population, 42% of the hospitalisations and 49% of the days spent in hospital.

Prof Inacio, who oversees the national database Registry of Senior Australians, said reducing the amount of time older people spend in hospitals is better for everyone, and the study offers practical recommendations to help this happen.

“Older people are usually on a lot of medication, for example. We found that after a certain number of medications they are at a higher risk of unplanned hospitalisations.

“Optimised medication management is one potential area that could be implemented through existing programs such as home medicine reviews. This is a Medicare-subsidised program for older people living in the community, yet it is not used as often as it should be.

“Frailty is also a significant predictor of hospitalisations, and this is another factor we could address following an ACAT assessment.

“If we invest in services and care that can help reduce frailty — things like encouraging physical exercise if possible, or comprehensive management with geriatric specialists and appropriate allied health professionals — we could improve older people’s quality of life and reduce the impact on our hospitals at the same time.”

The study is part of the wider State Action on Avoidable Rehospitalisations and Unplanned Admissions in South Australia (STAAR-SA) project, which involves collaboration with SA Health, all state local health networks and several stakeholders from both the healthcare and aged-care sectors. The project is funded by the National Health and Medical Research Council accredited Health Translation SA, through the Medical Research Future Fund Rapid Applied Research Translation Program.

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