How does access to social care influence health care utilisation for older adults?
Adult social care is facing financial constraints and increasing demands from an ageing population. Deficiencies in social care are thought to have profound implications for health services, but to date, there has been no robust synthesis of evidence on how access to social care influences health care use in either primary or secondary care. This systematic review was undertaken to determine the relationship between access to social care and a range of health care utilisation outcomes for older adults. Access was conceptualised using Gulliford and colleagues (2002) model of four domains: availability and supply, utilisation, quality and relevance, and equity.
Systematic searches of published and grey literature were conducted in 11 electronic databases (Medline; Embase; Scopus; Health Management Information Consortium; EBM Reviews: Cochrane Database of Systematic Reviews, NIHR Health Technology Assessment, NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effectiveness; SCIE Online; ASSIA). Reference lists of relevant systematic reviews, and publications of known experts were also checked. After deduplication, this yielded in 11538 records. After title and abstracts screening, 313 records were selected for full text review. Forty five studies reported in 46 publications met the inclusion criteria.
The included studies were mapped against the four accessibility domains. Some studies looked at health care utilisation outcomes according to more than one domain, and thus the following categories are not mutually exclusive: 19 studies reported evidence about the influence of the social care availability and supply; 28 studies reported evidence about the influence of social care utilisation; no studies were identified that reported evidence about the influence of social care quality or equity. Seventeen types of health care utilisation outcome were reported. These were typically secondary care outcomes. Primary care use outcomes were reported in just two studies. Studies are being quality assessed, and data extracted and synthesised. Emerging findings suggest that greater availability and supply of nursing and residential care is associated with reductions in delayed discharges, hospitalisations, length of hospital stay, and emergency readmissions. This evidence is weighted towards UK studies. There is also some limited evidence that residential and nursing care may have more of a beneficial impact than home care on health care utilisation outcomes.
This review will offer a novel and timely insights into the relationship between use and availability of social care for older adults and health care utilisation. The paucity of evidence on the impact on primary health care and equity suggest that they are areas where further investigation is required.