SOCIAL DETERMINANTS AND OLDER PEOPLE HOSPITAL OUTPATIENT NON-ATTENDANCE

Abstract Ref: 
0062

Charlie Dunmore1,2, Lucinda Baldwin1, Asan Akpan1
1Aintree University Hospital, Liverpool, UK
2School of Medicine, University of Liverpool, Liverpool, UK

Background: Missed outpatient appointments cost the health services millions every
year. Rates are particularly high amongst clinics designed for older people, many of
whom later attend the accident and emergency department (AED) and require admission.
The purpose of this project was to examine reasons for non-attendance, including the
demographics and level of area deprivation.

Methods: Patient information was retrieved from routinely collected data in those aged
65 years and above, for those who did not attend (DNA) their hospital outpatient older
people’s clinic between January and December 2016. Data analysis was conducted on
multiple variables, including age, area deprivation, reasons given for late cancellations and
AED attendances. The Index of Multiple Deprivation (IMD) was used to assign the
patient’s postcode to their appropriate Deprivation Quintile to allow comparison between
different areas.

Results: The overall rate of non-attendance was 13.29%. 59% of these non-attenders
were aged over 80. IMD analysis revealed that 49% of patients fell into the 5th Quintile,
more than quadruple the number in any other group. Amongst those who cancelled,
45% were ill and 14% were admitted so could not attend. Further analysis into reasons
for cancellations found that illness was consistently the leading reason across all age
groups. A total of 268 people attended the AED in the 3 months following, with 88%
being classed as Majors. 55% of these AED presentations were found to be aged over
80.

Conclusions: Those aged 80 and over were most likely to not attend, with illness being
the main reason. The majority were from the most deprived areas and presented to hospital
with a major illness. Further work and interventions need to be conducted to
explore these findings, as there is a suggestion of missed opportunities to provide equitable
access.