Health care pathways of elderly people hospitalized in an irrelevant way: qualitative and economic analyses

Aging is gradually accompanied by the onset of dependency, in terms of functional limitations and activity restrictions. INSEE forecasts an increase of almost 20% in the number of dependent elderly people by 2020. This demographic trend needs to be anticipated, so that we can organize and implement care adapted to the needs of the elderly, whether they live in institutions or at home. Almost 17% of emergency room admissions for patients over 75 are considered unjustified. They are qualified as "irrelevant" hospitalizations, as they do not require the use of the technical platform or medically supervised diagnostic or therapeutic procedures. These hospitalizations are irrelevant because the patient receives paramedical and social care that could be provided at home or in more efficient structures better adapted to the patient's needs. The hospital remains the place of recourse for social and health situations that could not be resolved due to a lack of available infrastructure, patient or family information, or a lack of coordination between medical and social structures. These "irrelevant" hospitalizations are accompanied by longer lengths of stay, further reinforcing the frailty and vulnerability of the elderly. It has been proven that the increase in hospitalizations of elderly patients, both in terms of duration and frequency, is deleterious to them in terms of decompensation, comorbidities, iatrogenesis and loss of autonomy.

The PAGE study, which aims to be comprehensive, will shed light on the shortcomings of current care through analysis of the discourses of the various players (main study). At the same time, a comparative analysis of the costs of care according to the healthcare pathway will be carried out (ancillary study).