• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Costs

National overview

Expenditure on hospital and community health services for older people in England was £16 470m in 2003-4, the latest year for which such data are available. ¹ This comprises:

• £10 590m on acute care

• £1930m on geriatric care

• £1800m on mental health

• £150m on learning disability

• £1080m on other hospital and ambulance services

• £680m on other community services

• £240m on central administration.

Gross expenditure by Social Services on older people in England was £8390m in 2005-6. ² Its net expenditure on older people was £6750m in 2005-6. This is net of income from user charges of £1640m. It comprises:

• £3280m for residential care

• £2560m for day and domiciliary services

• £910m for assessment and care management.

The day and domiciliary services figure includes £1650m for home care, £320m for day care, £90m for equipment and adaptations, £150m for supporting people, and £330m for other services.

The Personal Social Services Research Unit at the London School of Economics estimates that total expenditure on long term health and social care for older people was around £13b (1.4% of gross domestic product (GDP)) in 2002. ³ This includes an estimated £3b expenditure on privately purchased care. The unit projects that to keep pace with expected sociodemographic pressures this will rise to around £26b in 2022 (1.8% of GDP) and to around £56b (2.6% of GDP) in 2041. This is based on a set of base case assumptions, including official population projections, constant disability rates, no change in patterns of informal or formal care, and real rises in unit costs of care of around 2% per year (in line with average earnings). The projection is inevitably sensitive to these assumptions.

Falls

Nearly half of all attendances at (A&E) departments by people older than 65 are the result of a fall. ⁴ In 1999 there were nearly 650 000 falls related attendances at A&E departments in the UK by people older than 65. ⁵

Hip fractures account for 50% of injury related hospital admissions and 66% of bed days for people older than 75. ⁶ The annual estimated cost to the NHS for hip fractures is £1.7b. ⁷

Delirium

Few UK data are available on which to estimate the impact of delirium on use of resources, but it is likely to be high. It is responsible for around seven additional bed days per patient per episode of delirium. ⁸ In the US the additional cost per patient was estimated at $2500q in 2004 (i.e. in addition to what an inpatient event would cost). ⁹