Social care needs linked to higher risk of avoidable hospital admissions, study finds

Older adults with social care needs are significantly more likely to be admitted to hospital in an emergency and to be admitted more often than those without care needs, according to new analysis from the National Centre for Social Research (NatCen).

The study, drawing on over a decade of data from the English Longitudinal Study of Ageing (ELSA) linked to NHS hospital records, finds that older adults with any social care needs, whether these needs are met or unmet, face significantly higher rates of emergency hospital admissions compared to those with no care needs at all. This suggests that support is frequently provided in response to crises rather than as a preventative measure.

The study found that roughly one in four emergency admissions among those with social care needs involved potentially avoidable conditions, compared to one in six admissions for those without such needs.

These admissions often related to falls, chest infections, or hydration issues which might have been managed through better community support.

Researchers analysed hospital admissions among adults aged 65+ between 2012 and 2023 and conducted in-depth interviews with older people living with care needs to understand how gaps in support contribute to hospital use.

Emergency admissions are highest among people receiving care

After accounting for age, health, wealth and other risk factors, the analysis shows:

• Older adults receiving help with mobility or personal care needs experienced nearly twice as many unplanned hospital admissions compared with those with no care needs.
• Those with unmet care needs had 44% more hospital admissions, while people with difficulties managing daily tasks such as shopping or medication had 25% more admissions.
• Around 31% of older adults with no care needs were hospitalised, compared with between 44% and 58% of those with care needs.

Interviews with older adults revealed that access to social care was often triggered by a hospital stay, commonly through “discharge-to-assess” pathways. Participants described long waits for assessments, confusion about entitlements, and care packages that did not fully meet their needs.

Across the study, emergency admissions were more likely among older adults who:

• live alone
• have a long-term limiting health condition
• have experienced a recent fall
• smoke

Martin Wood, Director of Longitudinal Surveys at NatCen said: “Our findings show that social care is too often arriving after a crisis, rather than preventing one. Even when people are receiving support, hospital admissions remain high, suggesting care packages may be insufficient or coming too late.

“With an ageing population and growing pressure on the NHS, earlier, better-coordinated social care could play a critical role in preventing avoidable hospital admissions and helping older people live independently for longer.”

Dr Elizabeth Webb, Head of Research, Age UK: “Around 2 million older people in England are living with unmet social care needs, and this important research shows the wider consequences of a system that is failing them. By linking social care data with NHS hospital records, the findings provide strong evidence that when social care doesn’t work, pressure on the NHS increases.

“This underlines the urgent need for meaningful social care reform, so older people can live with dignity and independence, while easing pressure on the NHS.”