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Meta-Analysis
. 2019 Jan 1;48(1):57-66.
doi: 10.1093/ageing/afy147.

Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis

G Spiers  1 , F E Matthews  1 , S Moffatt  2 , R O Barker  1 , H Jarvis  1 , D Stow  1 , A Kingston  1 , B Hanratty  1
Affiliations
Meta-Analysis

Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis

G Spiers et al. Age Ageing. .

Abstract

Objective: to investigate the impact of the availability and supply of social care on healthcare utilisation (HCU) by older adults in high income countries.

Design: systematic review and meta-analysis.

Data sources: medline, EMBASE, Scopus, Health Management Information Consortium, Cochrane Database of Systematic Reviews, NIHR Health Technology Assessment, NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effectiveness, SCIE Online and ASSIA. Searches were carried out October 2016 (updated April 2017 and May 2018). (PROSPERO CRD42016050772).

Study selection: observational studies from high income countries, published after 2000 examining the relationship between the availability of social care (support at home or in care homes with or without nursing) and healthcare utilisation by adults >60 years. Studies were quality assessed.

Results: twelve studies were included from 11,757 citations; ten were eligible for meta-analysis. Most studies (7/12) were from the UK. All reported analysis of administrative data. Seven studies were rated good in quality, one fair and four poor. Higher social care expenditure and greater availability of nursing and residential care were associated with fewer hospital readmissions, fewer delayed discharges, reduced length of stay and expenditure on secondary healthcare services. The overall direction of evidence was consistent, but effect sizes could not be confidently quantified. Little evidence examined the influence of home-based social care, and no data was found on primary care use.

Conclusions: adequate availability of social care has the potential to reduce demand on secondary health services. At a time of financial stringencies, this is an important message for policy-makers.

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Figures

Figure 1.
Figure 1.
PRISMA flowchart of study selection.
Figure 2.
Figure 2.
Influence of social care and homecare on delayed discharges and length of stay. (a) Impact of availability of beds on delayed discharge. (b) Impact of availability of beds on length of delay. (c) Impact of availability on length of stay.
Figure 3.
Figure 3.
Influence of social care and homecare on emergency hospitalisations and costs. (a) Impact of availability of emergency readmissions. (b) Impact of expenditure on emergency readmissions. (c) Impact of social care expenditure on hospital care expenditure.
See this image and copyright information in PMC

Comment in

References

    1. The King’s Fund A new settlement for health and social care. Final Report. Commission on the Future of Health and Social Care in England. The King’s Fund, 2014.
    1. Mortimer J, Green M Briefing: The Health and Care of Older People in England 2015: Age UK, 2016.
    1. The Press Association Leading Medics Heap Pressure On Government To Adequately Fund Social Care. 2016. http://www.careappointments.co.uk/care-news/england/item/40844-leading-m... (accessed 28.11.2016).
    1. Harper S. Economic and social implications of aging societies. Science 2014; 346: 587–91. - PubMed
    1. Comas-Herrera A, Wittenberg R, Costa-Font J et al. . Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom. Ageing Soc 2006; 26: 285–302.

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