Age and Ageing Advance Access originally published online on July 25, 2005
Age and Ageing 2005 34(5):480-485; doi:10.1093/ageing/afi152
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Research Paper |
Increased use of emergency services by older people after health screening
1 Department of Primary Care and Social Medicine, Imperial College, London, UK
2 School of Population Health, University of Queensland, Herston Road, Herston, Queensland 4006 and University of Western Australia, Australia
3 Brook Green Medical Centre, London, UK
4 Sands End Clinic, London, UK
Address correspondence to: K. Jamrozik. Fax: (+61) 07 33 65 54 42. Email: k.jamrozik{at}sph.uq.edu.au
Abstract
Background: evaluation of the ‘Keep Well At Home’ (KWAH) Project in West London indicated that a programme of screening persons aged 75 and over had not reduced rates of emergency attendances and admissions to hospital. However, coverage of the target population was incomplete. The present analysis addresses ‘efficacy’—whether individuals who completed the screening protocol as intended did subsequently use Accident & Emergency (A&E) services less often.
Methods: the target population was divided into five groups, depending on whether an individual had completed none, one or both phases of screening, and whether deviations from the protocol related to incomplete coverage or refusal to participate further. We ascertained use of emergency services before screening and for up to 3 years afterwards by linkage of records from KWAH to those of local A&E Departments. Patterns of emergency care were examined as crude rates and, via proportional hazards models, after adjustment for available confounders.
Results: there was an increase of 51% (95% CI 22–86%) in the crude rate of emergency admissions in the year after first-phase screening compared with the 12 months before assessment. This was most obvious in individuals deemed at high risk who also underwent the second-phase assessment (adjusted hazard ratio relative to individuals not ‘at risk’=2.33; 95% CI 1.59–3.42).
Conclusions: the available data do not allow us to distinguish between several possible explanations for the paradoxical increase in use of emergency services. However, what seem to be sensible policies do not necessarily have their intended effects when implemented in practice.
Keywords: screening, elderly, emergency services, efficacy, iatrogenesis
Received December 23, 2004; accepted in revised form June 15, 2005.