A new study of nearly a million emergency admissions in Norway has found increased mortality in the elderly who live in the countryside compared to those that live in the city.
Research shows that elderly people living in rural areas have higher mortality rates if they are discharged to a municipality under pressure. Additionally, the research found that elderly people over the age of 70 who live in a municipality with fewer than 10,000 inhabitants are particularly vulnerable.
The research has been carried out in light of the growing population in Norway which is set to see 250,000 more Norwegians over the age of 80.
The study
Gudrun Maria Waaler Bjørnelv, associate professor of Health Economics at NTNU, is concerned that municipal authorities in Norway may not be prepared for an ageing population.
Working with a research team from NTNU, St. Olavs Hospital, Trondheim Municipal Authority and SINTEF, Bjørnelv has studied all Norwegians over the age of 70 who were admitted to emergency departments from 2012 to 2016, which amounted to just over 350,000 people.
This group of elderly people had almost 900,000 emergency hospital admissions during this period. The researchers followed them for 30 days after the day they were admitted.
Nursing and care services that were under pressure led to increased mortality in elderly who were under their care, and that elderly people in small municipalities had the highest mortality rate.
A small municipality was defined as having fewer than 10,000 inhabitants. According to Statistics Norway, 70% of Norwegian municipalities in 2016 had fewer than 10,000 inhabitants. In total, 17% of the population lives in a small municipality.
Bjørnelv stated: “Previously, it was thought that small municipalities do better than large municipalities, because they have fewer patients in hospitals waiting to be discharged to the municipal services.
“Our findings, however, indicate that small municipalities are more vulnerable during periods when the demand for nursing and care services is higher than the municipality can supply.”
“We need to take a closer look at the municipal services, and it needs to happen now.”
Bjørnelv points out that small municipalities may experience more pressure regarding demand for available nursing home places and health professionals.
“This may make them more vulnerable to fluctuations and pressure on health services,” Bjørnelv said.
To investigate how mortality rates among patients changed, the researchers relied on information regarding the amount of pressure individual municipalities were under.
“If there is a build-up of patients who are ready to be discharged from hospital to one municipality, this suggests that the municipal services such as home care and nursing homes are under pressure. It shows that they do not have the capacity to receive these patients,” stated Bjørnelv.
The study investigated how mortality rates changed if people were admitted to emergency departments during periods of increased pressure in the municipality. That would be during periods where many people from the same municipality as the acutely admitted patient were waiting to be discharged from hospital.
“Is there a greater tendency to move some people home after hospitalisation rather than to a municipal short-term care facility if the municipality is under pressure? Is it better for elderly people from a pressured municipality to longer in the hospital – without the municipality having to pay a ‘fine’ to the hospital? What is best for the patient?” Bjørnelv said.
