Patterns in health service utilisation: Results from Wave 5 of The Irish Longitudinal Study on Ageing

Abstract

The purpose of this report is to examine social and health care service utilisation among older adults in the latest available wave (i.e. Wave 5) of The Irish Longitudinal Study on Ageing (TILDA) – both community and hospital services. These data were collected during the 2018 calendar year, and we provide corresponding estimated number of service users by using data from the latest available census in the Republic of Ireland (Census 2016). We examine these data nationally, and by county and age group (0= aged 50-69, 1= aged ≥70). We have selected these age groups in light of the focus of the Irish government on adults aged 70 or more as an at-risk group during the outbreak of COVID-19 in Ireland [1]. Our data show that service use in adults aged 50 and older is low; this is consistent with our previous reports [2], underscoring the fact that the majority aged 50 and over are active and make significant contributions to the social and economic fabric of Irish society. These contributions include, notably in the context of this report, the provision of informal care to their spouses, relatives, friends and neighbours [3]. The prevalence of frailty increases with age, from 11% in adults aged ≥50, to 18.9% of adults aged ≥70, according to the Fried phenotype [4] measure of frailty, and 28.1% of adults aged ≥70 who live alone are frail [5]. Frailty and living arrangements often place older adults in need of support from health care services. Frailty places an older adult at increased risk of falls, disability or hospitalisation. Older adults who live alone and experience difficulty in daily activities (e.g. getting out of bed, going to the toilet) will require help from outside their home, such as an informal carer or State-provided home care, or services such as meals on wheels. In our data, only a small proportion of adults aged ≥70 received services in their home, for example home care (8.35%), the Public Health Nurse (7.91%), meals on wheels (1.33%) or home care package (1.23%). By contrast, 97% reported having visited the General Practitioner at least once in the previous year. Finally, while we report increased healthcare utilisation in older adults aged ≥70, we note most of this relationship is explained by the older adults’ biological age (e.g. frailty, disability, chronic disease) as opposed to their chronological age [6, 7].