Variation in care home admission across areas of Northern Ireland.
BACKGROUND
much has been written about the demographic and health characteristics which act as risk factors for care home admission in the UK. However, few studies have examined variation in care home admission rates across areas, whilst controlling for the demographic and health characteristics of the individuals living within these areas. This is surprising given that decisions which affect admission are often taken at the local level. The aim of the study was to determine if there were variations in care home admission rates across trusts in Northern Ireland, once adjustment had been made for the demographic and health characteristics of the individuals residing within these areas.


METHODS
a retrospective cohort study was undertaken, using data from the Data Retrieval in General Practice (DRGP) project in Northern Ireland, to identify a cohort of individuals aged 65 and over and living in the community at the outset of the study. A total of 28,064 individuals were followed up for 5 years to identify those who subsequently entered a nursing or residential care home. Controlling for the demographic, household composition and health characteristics of individuals, Poisson regression was used to estimate the incidence rate ratios of care home admission for 10 trusts.


RESULTS
a total of 24,691 of the initial cohort had complete information for all variables and were included in the final analysis; 1,313 (5.3%) had entered a care home at the end of the 5 years of follow-up. Admission increased significantly with age, and diagnoses of dementia and stroke. Controlling for the age, sex and health composition of individuals, some variations in admission rates were found across trusts.


CONCLUSIONS
the study has highlighted the importance of age and clinical conditions as risk factors for care home admission. In addition, it appears that the area of residence might be important in determining a person's risk of care home admission. Such differences may be attributable to particular characteristics of the trust, such as the level of deprivation or degree of rurality, or to differing policies in relation to services for older people. More work is required to identify the causes of the differences to allow policies to be implemented to ensure equitable access to care homes across Northern Ireland.
Connolly
Sheelah
S
Epidemiology and Public Health, Queen's University Belfast, Royal Victoria Hospital site, Belfast, UK. sheelah.connolly@qub.ac.uk
O'Reilly
Dermot
D
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009660:Northern Ireland; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D012189:Retrospective Studies; D012307:Risk Factors