Living alone matters Linking data to explore the connection between older people living alone and A&E attendance
13 December 2018
I’ve always admired my grandmother’s fierce independence. She worked as a nursing sister caring for people with dementia, raised six spirited children and always made space for stray dogs in her home (at one stage, 11 followed her around adoringly).
For as long as I can remember, she’s told the family that she wanted to live alone in her old age. She did this well into her 80s until a nasty fall raised questions about whether she should continue. Was it safe? Did she need help?
While some people, like my gran, choose to live on their own, other people might not have a choice. Currently, one in three people over the age of 65 live alone in the UK – a figure that is set to increase by more than 50% over the next 25 years.
Living alone can increase a person’s risk of social isolation and loneliness and have a negative impact on their health and wellbeing. A lack of social connection is proven to be harmful to our health – comparable to smoking 15 cigarettes a day. To address this issue, the Prime Minister recently launched the government’s first strategy on loneliness. It highlights the need for strong social relationships and sets out a vision for how to create a more connected society.
For those who do live alone, it’s important that the NHS has data to understand their health needs, which may differ from those living with others. Living alone may make accessing health care services harder – it might be more difficult getting to and from GP or hospital appointments without support from those you live with.
Using linked data to understand the households we live in
We know that our housing and who we live with influences our health. But research to date has provided mixed evidence about the link between living alone and health service use, particularly in older people. To explore this relationship, we designed a data-linkage study that has been published in BMC Geriatrics.
We worked in collaboration with a large multi-site GP practice in London, Valentine Health Partnership, to examine the impact of living alone on number of GP appointments, A&E attendances, outpatient appointments and hospital admissions for patients aged 65 and over. This piece of research is the second in our series of data-linkage projects looking at the link between who people live with and their use of health care services.
Health care needs of older people living alone
Just over half of older patients in our study lived alone. Of the patients living alone, 50% had three or more long-term conditions and 25% had a mental health condition. Approximately 40% of patients living with others had three or more long-term conditions and 20% had a mental health condition. People living on their own were more likely to be older, had more long-term illnesses and were more likely to have a mental health condition.
The most interesting results from the study were that older patients living alone were 50% more likely to go to A&E compared with those who lived with friends or family (after adjusting for age, sex, deprivation and long-term conditions). In the general practice, the most frequent users of GP appointments visited once a month on average - this was 18% of patients aged 65 and over. Older patients living alone were 40% more likely to be in this ‘frequent user group’, compared with those who lived with others.
The data did not allow us to explore the reasons why older patients living alone go to the GP and A&E more often than those living with others. However, there are a few possibilities. One is that patients living alone are at greater risk of not engaging in preventative services, or are lonely, which can result in poor health. Another possibility is that patients living alone simply require additional support during periods of ill health, compared with those who may receive this support from a family member. Those living alone may need extra help from the NHS to coordinate their care or manage their conditions. It’s also possible that patients living alone may be lonely and visit the health service for social connection.
What can be done to support older people living alone?
Given there is a growing population of older people living alone with complex health needs, and that these patients make greater use of health services, the NHS needs to adapt.
The government’s strategy on loneliness promises support for all local health and care systems to implement social prescribing programmes by 2023. This means that GPs will be able to refer patients to community programmes, such as knit-and-natter groups and exercise clubs. This provides GPs with a range of non-medical options and allows them to think more holistically about patient care. However, further investigation and evaluation of the effectiveness of social prescribing for combating loneliness is needed to identify which interventions should be prioritised.
After many discussions, my gran decided that it was time to move, but only if Puggy (the last of the adoring dogs) came with her. Her children rallied round to find living arrangements that would work for her. However, not everyone is lucky enough to have that kind of support system.
Kathryn Dreyer is a Principal Data Analyst at the Health Foundation.
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