Use of acute services by patients who die in NHS hospitals does not increase with age according to new research

Use of acute services by patients who die in NHS hospitals does not increase with age according to new research by the University of Bristol published in the British Medical Journal today.

Professor Shah Ebrahim and colleagues in the University’s Department of Social Medicine analysed hospital episode statistics for England for the financial year 1999 (1 April 1999 to 31 March 2000). 

They identified all episodes (excluding births) that resulted in a patient’s death and then, using records of each patient’s previous hospital admissions, calculated the total number of days spent in hospital and the number of separate admissions in the three years before death.

• 253,799 in-hospital deaths were identified, representing about 45% of all deaths occurring in 1999-2000. 

• Patients who died in hospital spent a median of 23 days in hospital in the three years before death.  The median rose with age up to 45 years, but was fairly stable for ages 45 and above.

• The number of admissions to NHS hospitals in the three years before death averaged 3.6; this peaked at 10.4 in patients aged 5-9 years and decreased with age to 2.2 in those aged 85 and over.

Neither total hospital days nor the number of admissions in the three years before death showed the expected positive relation to age at death.  The researchers found no increase in average total bed days or number of admissions after the age of 45 years, and in fact the group most likely to have had multiple admissions were children. 

Professor Ebrahim said: “With life expectancy increasing in most countries, population ageing has become an important issue worldwide.  This has led to concerns about the impact this will have on health care systems, given the almost exponential relation between age and many diseases. 

“Our findings show that the highest proportion of costs for acute care are incurred in the final years of life, no matter at what age this happens to be, and that total costs of acute care are greater in elderly people simply because this age group makes up a larger proportion of dying people.  Such findings have important implications for understanding the use of acute hospital resources and for distinguishing the costs of dying from the costs of ageing.”

Paper: Tracy Dixon, Mary Shaw, Stephen Frankel, Shah Ebrahim: ‘Hospital admissions, age, and death: retrospective cohort study’, British Medical Journal, doi 10.1136/bmj.38072.481933.EE(published16 April 2004)