Demographic and social change: implication for use of acute care services by older people in Scotland[Changements démographiques et sociaux: implications pour l'utilisation des soins de santé en urgence par les personnes âgées en Ecosse]

Rapidly rising numbers of emergency hospital admissions among older people have been the major source of pressure on the NHS in Scotland in recent decades. Conventional wisdom long held that this was mainly a reflection of an ageing population. This paper shows that factors such as demographic change, changing morbidity and pressure on informal care have played the lesser explanatory role. The bulk of the explanation lies in the how the system has delivered care. Rising emergency hospital admissions primarily are a reflection of a system which has tended to provide fragmented, ‘crisis-management’ care rather than the co-ordinated and preventive care more appropriate to the management of long-term conditions in an ageing population.