Patterns of healthcare utilisation in older people

: secondary data analysis of service evaluation and epidemiological data

Abstract

Advances in life expectancy without commensurate improvement in healthy life expectancy has resulted in increased demand for healthcare services, particularly among older adults. Consequently, healthcare services must adapt to accommodate this increased demand. Influences on healthcare service usage are multidimensional, including demographic, social and health need factors; those which are modifiable serve as potential targets for intervention to improve capacity and service delivery. Novel models of pharmaceutical care for older adults have been developed within intermediate care and care homes in Northern Ireland, providing an opportunity to explore individual variation in healthcare usage by older adults. Older adults are more sensitive to medications and often receive inappropriate prescribing. Thus, improving prescribing appropriateness, via pharmacist intervention, may serve as a modifiable target with respect to health service usage by older adults. Secondary data analysis of data from the Northern and Western Health and Social Care Trusts was conducted to evaluate the effectiveness of pharmacist case management in intermediate care (N=532) and care home (n=1095) settings. A significant reduction in inappropriate prescribing was achieved in both settings, with pharmacist intervention types found to influence subsequent healthcare resource usage. Previous healthcare utilisations were consistently predictive of post-intervention healthcare usage. Longitudinal patterns of healthcare utilisation were explored in a complementary cohort. A latent transition analysis of The Irish Longitudinal Study of Ageing (TILDA) (N=8175) identified heterogeneity in healthcare utilisation by community dwelling older adults. Three latent statuses of usage were identified across three data collection waves: ‘effective referral’, ‘multiple utilisation’ and ‘primary care only utilisation’. Variation in longitudinal healthcare utilisation was influenced by a range of factors including the number of medications, frailty, falls and depression. This thesis serves to extend theory regarding healthcare utilisation specific to older adults, advocating for an integrated approach to healthcare delivery in order to address the needs posed by multi-complexity.

Date of Award	Jan 2021
Original language	English
Supervisor	Gary Adamson (Supervisor), Mark Shevlin (Supervisor) & John Mallett (Supervisor)