Older people

In our latest indicator update we look at trends in the quality of care for older people.

Indicator update

Published: 29/10/2019

Advances in healthcare and improvements in public health have meant that people in the UK are living longer than ever before. But the extra years of life are not always spent in good health, and this is particularly the case for older people living in poverty. Older people are more likely to have multiple chronic health conditions, be frail and have reduced social support networks. As a result, they have a higher need for health and social care services than people of other ages. The quality of NHS and social care services – from GP visits and help at home, to ambulance calls and hospital admissions – disproportionately affects older people. And when the capacity of services is struggling to keep up with demand, older people will be impacted the most.

This month, we have updated a group of QualityWatch indicators that particularly relate to older people, to give an overview of how their quality of care has changed over time. Find a summary below, with links to more detailed content and analysis.

Flu vaccination coverage

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  • The ambition for flu vaccine coverage is to reach or exceed 75% uptake for people aged 65 years and over, as recommended by the World Health Organisation (WHO). In England, the WHO target was last met in the winter of 2005-06, when flu vaccine uptake reached 75.3%.
  • Notably, there was a drop in flu vaccine uptake to 70.5% in 2016-17, which has since recovered slightly to 72% in 2018-19.
  • Between 2007 and 2017, the UK had some of the highest levels of flu vaccination coverage among those aged 65 and over compared to other OECD countries.

Injuries due to falls

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  • Patients in hospital should receive the help and support they need to prevent falls and injuries such as hip fractures. And all patients with a hip fracture should be operated on promptly, to improve the outcome.
  • In England, the percentage of hip fractures that happened in hospital (rather than in homes, care homes and outside) decreased from 5.4% in 2013 to 3.8% in 2015, where it has remained fairly steady since then. The proportion is higher in Wales but lower in Northern Ireland.
  • The percentage of hip fracture cases having prompt surgery (within 36 hours) has fluctuated over time in England, Northern Ireland and Wales, but at different levels. On average, 75% of hip fracture patients in England have surgery within 36 hours, compared with 63% of patients in Wales and only 24% of patients in Northern Ireland.

Supporting older people’s recovery after illness or injury

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  • Reablement services aim to maximise people's independence and ability to live at home, in order to minimise their need for ongoing support and dependence on public services. They tend to be provided to older people who have just been discharged from hospital or are entering the care system following a crisis.
  • One measure of care quality is the proportion of people aged 65 and over who are still at home 91 days after discharge from hospital into reablement services. The proportion of older people still at home after 91 days has varied little over time, reaching 82% in 2018-19.
  • The proportion of older people who receive reablement services after discharge from hospital has fluctuated over time at around 3%. In 2018-19, 2.8% of older people discharged from hospital received the service.

Care home bed availability

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  • Between 2012 and 2018, the number of beds in care homes (nursing and residential) per 100 people aged 75 and over declined from 11.3 to 10.1 – a 10% decrease. Likewise, the number of nursing home beds per 100 people aged 75 and over fell from 5.2 to 4.9 – a 7% decrease.
  • The shift in social care policy towards providing care at home rather than in residential settings, may explain some of the fall in bed availability. But without reliable data on the number of people receiving home care, it could also indicate a fall in social care provision for older people.

Admissions to care homes

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  • For older adults (aged 65 and over), the rate of admissions to care homes decreased from 658 per 100,000 people in 2014-15 to 579 per 100,000 people in 2018-19.
  • The decrease in the number of admissions of older adults to care homes could be interpreted as an improvement in the quality of home-based social care, resulting in delayed admission. But it could also represent a fall in social care provision, which comes at a time when the population is ageing.

Delayed transfers of care

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  • The average number of patients delayed per day fluctuated at around 3,800 between 2010 and 2013. After this, the number increased rapidly to reach a peak of 6,660 patients delayed per day in February 2017. Since then the number has decreased, falling to an average of 4,802 patients delayed per day in August 2019.
  • In August 2019, around two-thirds of delayed transfer of care patients were receiving acute care and one-third were receiving non-acute care.
  • The NHS is responsible for the majority of delayed transfers of care. In August 2019, the NHS was responsible for 60% of patients delayed, social care was responsible for 30% of patients delayed, and both the NHS and social care were responsible for 9% of patients delayed.
  • Since July 2016, the most common reason behind delayed transfers of care is people awaiting a care package in their own home.

Emergency readmissions

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  • Between 2013/14 and 2017/18, the number of 30-day emergency readmissions to hospital in England increased by 15%, from 758,955 to 869,155. The rate of emergency admissions increased from 12.4% in 2013/14 to 13.7% in 2017/18.

Dying at home

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  • The proportion of people dying at their usual place of residence (home, care home or religious establishment) has increased substantially over time, from 35% in 2004 to 47% in 2018. Despite this, over half of deaths are still occurring elsewhere (for example, in hospitals and hospices), so more improvement is needed in this area.

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