United Kingdom : Elderly no More a 'Burden' on NHS than Any other Dying Patient  

By Tara Womersley, the Scotsman  

April 16, 2004

OLDER people are not the burden on the health service that we are led to believe, researchers have found.  

A study of more than 250,000 patients has shattered the preconception that admissions to hospital and length of stay increase with age.  

Researchers analysed the medical needs of people of different ages in the three years leading up to their death. The results suggested that healthcare needs increased closer to death, regardless of age.  

The findings, published on the British Medical Journal's website, looked at the deaths of 254,000 patients who died during 1999 and 2000, and then looked at hospital admissions three years before their death.  

Shah Ebrahim, a professor in the epidemiology of aging at Bristol University 's department of social medicine, said: "What we demonstrated is that it is not so much old age that causes increased hospital admissions, but the process of dying. The issue is one that is subtle as we have more people in their eighties and nineties than there were 20 or 30 years ago, and obviously being old makes it more likely that you will be closer to time of death.  

"But it is not actually old age of itself that places a burden on health service, and the populist view that old people are a burden on health service is quite wrong; it is more that people who are dying are a burden to the health service."  

Researchers found that patients spent an average of 23 days in hospital in the three years before their death. However, the number of days spent in hospital rose until the age of 45, after which the figure remained fairly constant.  

Patients were also likely to be admitted to hospital an average of 3.6 times before their death, but the number of admissions was highest among children aged between five and nine, who experienced an average of ten admissions. The number of admissions declined with age, reaching about two admissions in the over-85s. Prof Ebrahim said: "Many older people have a desire to be at home during their last illnesses, and about half of all deaths occur at home.  

"Another factor is that for an increasing number of old people, particularly the very elderly who are over 85 and in a nursing home, the need for hospital admission becomes less.  

"But there is an inherent ageism in society to view elderly people as a stereotypical frail burden, using up resources. "This work contradicts that stereotype, showing that actually the highest proportion of cost for hospital care arises in the final years of life, no matter what age this happens to be at, and so of course the total cost of acute care will be greater in elderly people simply because older people make up the larger proportion of those who are dying."  

Andrew Sim, a policy officer for Age Concern Scotland , said: "It is refreshing to see such research which challenges the misconception of older people as a crippling burden on the younger population. These misconceptions promote a terror of aging, when what we should bear in mind are the contribution of people over 50 to the wealth in the UK and the savings of unpaid work among older people, which includes grandparenting, caring for partners and volunteering.  

"There is a general perception as well of older people being a problem in health terms, such as delayed discharge, and this study challenges some of the ageist misconceptions."  

A recent study by Age Concern stated that the over-50s created a quarter of the country's economy, with their contribution for paid work making an annual value of £201 billion across the UK . Unpaid work by older people was estimated to be worth £24 billion.  

There were 804,900 people over 65 living in Scotland , according to the 2001 Census compared to 767,147 a decade earlier. The number of pensioners is also set to increase, from 17.9 per cent of the population in 1998 to 24 per cent of the total population by 2036.