Hospital downsizing and trends in health care use among elderly people in British Columbia

Background: There has been considerable downsizing of acute care services i n British Columbia over the past 2 decades. In this population-based study we examined changes in the proportion of elderly people who used acute care , long-term care and home care services between 1986-1988 and 1993-1995 to explore whether the downsizing has influenced use. Changes in death rates w ere also examined. Methods: The British Columbia Linked Health Database was used to select all British Columbia residents aged 65 years, 75-76 years, 85-87 years or 90-9 3 years as of Jan. 1, 1986 (cohort 1), and Jan. 1, 1993 (cohort 2). Each pe rson was assigned to 1 of 6 mutually exclusive categories of health care us e reflecting different intensities of use (i.e., hospital, long-term or hom e care). The proportions of people within each category were compared betwe en the 2 periods, as were the age-standardized death rates. Results: There were 79 175 people in cohort 1 and 92 320 in cohort 2. Overa ll, the relative proportion of people in each use category was similar betw een the 2 study periods. The most substantial changes were an increase of 2 percentage points in the proportion of people who received no facility or home care services and a decrease of 2 to 3 percentage points in the propor tion who received some acute care but no facility-based continuing care. Th e age-adjusted all-cause death rates for the earlier and later cohorts were virtually identical (15.7% and 15.8% respectively), although the rate incr eased from 63.6% to 70.1% among those in the "full-time facility with acute care" group. Interpretation: Overall changes in health care use were small, which sugges ts that the repercussions of the decline in acute care services for elderly people have been minimal. The higher age-adjusted death rates in the later cohort in full time care suggests that long-term stays are becoming reserv ed for a sicker group of elderly people than in the past.