Health Care for the Elderly; How Reliable Are the Statistics?

Health care for the elderly, looking at the statistics.

Definition of elderly is people over the age of 65, I am one of these.

Government policy, all around the world, is based on statistical information, it is used to justify policies and expenditures; but how good a guide for future policies are the statistics?

We hear and read so much about how elderly patients are clogging up the public health services, so I am trying to sort facts from headlines. Statistics can be helpful, they can also be misleading, trying to sort one from the other is difficult. I am basing this essay on British statistics since they are the most reliable that I have easy access to. I expect there are similar situations in most “developed” nations.

So much of the information supplied to decision makers comes from reports issued by groups with a vested interest in policy decisions. The big pharmaceutical global companies devote large resources to producing information to guide policy makers. They are obviously not going to issue information detrimental to their business.

The national audit office report, on reducing emergency admissions, states that 65 percent of hospital emergency bed days were occupied by patients aged 65 or over

This same report states that there were 5,800,000 emergency admissions in 2016-17, this is a 2.1 percent increase but it also says 32 percent of local areas had reduced emergency admissions due to better care fund plans. It also shows that 79 percent of the growth in admissions is accounted for by people who did not stay in hospital. The report also shows that between 2014-5 and 2016-17, the number of people aged over 65 grew by 6.2 percent but emergency admissions for this age group grew by 12 percent. It does not state—or at least I have not found it yet—whether the number of emergency beds, and so days available, has been reduced, since 2014. Obviously less beds increases percentage occupation in remainder.

These figures imply that a larger proportion of elderly people are seeking emergency hospital treatment than had done so previously. Why is this? There are press reports of increased waiting times to get appointments to see general practitioners and this would account for more people going to accident and emergency hospitals since they feel they can not wait three weeks to see their doctor. This increase in proportion may be due to shortcomings in the general practitioner services rather than increase illness in the over 65 age group. There is also the reduction in “out of hours” GP services and in home visits. If you are ill and not able to get out, while the doctor will not come to you, then you call the emergency service. So it is possible, even likely, that much of this increase in elderly use of emergency hospital admissions is caused by a deterioration of the general practitioner service. It is also relevant that if a patient sees their GP and they arrange a hospital admission, this is not treated statistically as an emergency admission. So the figures get distorted when seeing your general practitioner is more difficult. If in 2014 it was easier to see your doctor and they “caused” the admission to hospital, it was not counted as an emergency admission.

Figures from NHS digital – the latest figures available to the public are for 2013-14.

The greatest number of admissions by age band was for patients aged 65 to 69 (1.3 million). This age band also saw the greatest increase in the number of admissions, up 5.5 percent (66,000) from 1.2 million in 2012-13.

All these statistics, especially when expressed as percentage of a total, can be misleading. Note that a report from the Kings Fund on hospital bed numbers past present and future; that was published 29, September 2017; shows that the number of overnight general and acute beds, has fallen by 43.4 percent between 1987-88 and 2016-17 Statistically, reducing the total number of beds available distorts the figures. For example, if there are 100 beds and 50 patients you have 50 percent bed occupancy, if you reduce the number of beds to 50 you have 100 percent bed occupancy. The number of admissions is indirectly linked to the number of beds, since you could not admit 100 people if you only had 50 beds.

The Office of National Statistics report that only 58 percent of babies born in 1920 lived to be 70 in 1990, while 78 percent of babies born in 1946 survived to be 70 in 2016. This makes it look as if there has been a huge increase in life expectancy. There was the second world war between 1920 and 1990 (when hundreds of thousands of people were killed by conflict. Some by being on active service, some by begin victims of enemy bombing raids) which must have affected the figures to the extent that the 58 percent is meaningless when compared to a period of relative peace.

If my adding up is accurate, the population projections from the Office of National Statistics for Britain show the population of people aged over 65, for years shown, are:

2016: 10,224,700

2017: 11,987,000

2018: 12,167,000

2019: 12,344,000

2020: 12,507,000

2025: 13,489,000

So, again if my mathematics are correct, between 2018 and 2025 (seven years) there will be an increase in those over 65 of 10.8 percent BUT not all of these will be needing public health care. I live in a small “community” of elderly people and at least three-fourths of us never call on emergency health care or need hospitalisation. I agree most of us probably have some form of prescribed medication—statins or blood pressure tablets but these are usually prescribed at the doctor's insistence rather than a person's request. How much we need is open to debate; we know that doctors are pressurised into prescribing these types of medication.

All statistics can be “managed” to give the impression you wish to give. Reliance on once source of statistical information is never wise. I could use the above figures to show that in the next seven years there will only be 1.5 percent year on year increase in the elderly population and since we can adjust for those not needing medical care and those who will be wealthy enough to pay for their own treatment and adjust again for those with private health care insurance, we could extrapolate to say the projected increase in health care need for the elderly is only 0.75 percent year on year increase. This could be statistically supported but is a rubbish claim. It is meaningless and it relies on guess work.