title: Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.
abstract: BACKGROUND
  Admission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage.
  
  
  METHODS
  The present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups.
  
  
  RESULTS
  33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories.
  
  
  CONCLUSIONS
  There appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trial Registry ACTRN12607000563460 >TrialSearch.
authors.affiliation: The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, 2000, Australia. ifarag@georgeinstitute.org.au.
authors.forename: I
authors.initials: I
authors.lastname: Farag
authors.affiliation: Institute for Choice, University of South Australia, North Sydney, NSW, 2060, Australia.|Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Howard
authors.affiliation: The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, 2000, Australia.
authors.forename: S
authors.initials: S
authors.lastname: O'Rourke
authors.affiliation: The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, 2000, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Randwick, NSW, 2031, Australia.
authors.forename: S R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Randwick, NSW, 2031, Australia.|Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, 2031, Australia.
authors.forename: J C T
authors.initials: JC
authors.lastname: Close
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Vogler
authors.affiliation: Faculty of Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Dean
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: R G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, 2000, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Sherrington
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005081:Exercise Therapy / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D010351:Patient Discharge / Q000191:economics*; D012944:Social Support; D012947:Social Work / Q000191:economics*
keywords: Costs; Hospitalisation; Mobility improvement; Older people; Resource use