Increasing demand on A&E from elderly patients due to lack of appropriate care elsewhere

Posted: 30/01/2014

The number of elderly patients over 90 brought to A&E by ambulance in England has risen by 81% in the past three years according to official data from the Health and Social Care Information Centre (HSCIC).

The Daily Telegraph reports that A&E doctors daily see patients who have been transported from their place of residence for injuries or illnesses such as basic chest or urinary tract infections which are easily treatable with oral antibiotics and do not require hospital care.

While this increase is partly related to the ageing population, this cannot alone account for the dramatic rise. Reported in BBC News, Dr Cliff Mann of the College of Emergency Medicine has suggested the "lack of good care" in the community is a key factor. He added that ambulance journeys for elderly patients resulted in "poor experiences for patients, unnecessary concern for relatives and increases in bed pressures". The increase could also be linked to the cuts in social care budgets which have prevented the elderly from receiving the community support they need. Others factors include the lack of confidence in out of hours care, which is also being hit by funding cuts.

Nadra Ahmed, chairman of the National Care Association, suggested in the Telegraph that doctors are to blame for a rise in elderly people being sent to A&E because of “critical changes” in the way GPs respond to calls  and their reluctance to make home visits to patients out of hours. She added that, if elderly people had the right support at home, conditions like urinary tract infections could be spotted and treated early and admission to hospital could be avoided.

Commenting on this data, Lucie Prothero, associate in the clinical negligence team at Penningtons Manches, said: “We deal with many enquiries relating to the medical treatment of the elderly and we find that elderly patients or their relatives will often talk about the frightening nature of their time in a busy A&E department, often compounded by the confusion of dementia. Attending A&E can be a disorientating experience for elderly patients and, if unnecessary attendances can be avoided without compromising their health and safety, we should aim for this goal.

“It is fair to say that, with greater support at home and good out of hours services, the number of unnecessary hospital admissions should be reduced. However, there must also be support in the community and this debate must not detract from the importance of ensuring that elderly patients who do require hospital care get the right management when they get there. We deal with many claims relating to the poor treatment of elderly patients in hospital, leading to avoidable hospital falls or the development of pressure sores for instance. It is clear that the pressure on A&Es needs to be relieved so that greater resources are available to ensure better care for those patients who do require admission to hospital.”

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