What is new and why it matters

This report offers an early, system-level picture of how elderly Ukrainians newly arriving in Israel interact with publicly funded services. It documents utilization across ambulatory care, emergency departments, inpatient admissions, and pharmacy fills, with a focus on care in the first months after enrollment and subsequent stabilization. The analysis adds evidence to refugee-health planning by isolating patterns specific to older adults who frequently carry multimorbidity, frailty, and complex medication regimens.

For front-line clinicians and service managers, several themes are immediately actionable. First, intake periods likely concentrate demand on primary care, laboratory testing, imaging, and specialist triage. Second, reliable medication reconciliation and refills are required to avoid lapses in control of chronic conditions such as hypertension, diabetes, chronic obstructive pulmonary disease, and cardiovascular disease. Third, the interface between community care and the emergency department must be managed to mitigate avoidable visits tied to gaps in navigation, access, or language barriers.

Because Israel integrates newcomers through national health funds, this cohort provides insight into utilization under a relatively cohesive coverage model. It allows observation of how older refugees use services when financial barriers are minimized but administrative, cultural, and clinical alignment still must be achieved. The patterns described here can help systems anticipate caseloads, prioritize clinical workflows, and calibrate outreach that targets high-risk seniors during the critical early phase after arrival.

Importantly, the cohort focuses on elderly adults. In this age group, morbidity clustering, functional decline, and social support constraints can amplify health service needs. Even without precise comparative rates, documenting the distribution of visits, admissions, and prescription activity across time windows contextualizes where demand is concentrated. This helps translate humanitarian reception into concrete staffing and scheduling decisions in primary care and hospital settings, and informs procurement for medications and supplies essential to chronic disease control.

Who was observed and what was measured

The cohort includes elderly Ukrainian arrivals enrolled into Israels public health system following displacement. Within that framework, the analysis reconstructs health service encounters captured in routine data: primary care visits, specialist consultations, emergency department presentations, inpatient admissions and length of stay, and pharmacy dispensing for maintenance and acute medications. Time since arrival is a central organizing variable, allowing separation of the immediate post-enrollment period from later stabilization periods.

Such a design offers coverage of the full care continuum, mapping an older adult journey from first contact to longitudinal management. It is well-suited to quantify the proportion of care anchored in primary care versus emergency or inpatient settings, and to detect temporal shifts as continuity is reestablished. In pharmaceutics, prescription fills and refills proxy for medication access and adherence support, while changes in medication classes can signal step-ups in control of cardiometabolic risk or symptom burdens such as pain and insomnia that often accompany resettlement stressors.

Key covariates likely include age bands within the elderly range, sex, baseline comorbidity burden, and markers of prior care disruption. Where available, language support, use of interpretation services, and presence of caregivers may influence utilization patterns by easing navigation and reducing avoidable acute care. Although not all such elements are captured in administrative data, their operational relevance is high. The observational frame therefore anchors decisions on what services to bolster during intake and how to connect older patients to community resources that stabilize health.

Because this is a retrospective cohort built from routine records, internal validity benefits from complete capture of covered services, while external validity is bounded by the specific context of Israels national insurance and reception policies. That context remains valuable for generalization to other publicly financed systems with centralized enrollment, even if the exact demand mix differs by local supply and population health profiles. Importantly, the design allows reasonable estimation of early versus later utilization without attributing causality, which aligns with the planning needs of health systems responding to a humanitarian inflow.

Within the data, several operational questions are central for clinicians and administrators:

• How quickly do older arrivals connect with a primary care clinician, and what is the average number of visits in the first quarter after enrollment?
• What share of urgent care is managed in primary care or same-day clinics versus the emergency department?
• How many inpatient admissions occur, and are they concentrated among specific chronic conditions or complications commonly seen in elderly populations?
• Do prescription fills for antihypertensives, diabetes therapies, inhalers, antithrombotics, and other chronic medications resume promptly, and are refills sustained over time?
• Are diagnostic services (laboratory, imaging) accessed at rates suggesting comprehensive baseline assessment and risk stratification?

Even without disclosing specific counts or rates, mapping these dimensions clarifies where to deploy interpreters, social workers, pharmacists, and nursing capacity. It also guides appointment slot allocation in primary care and specialty clinics, anticipates laboratory throughput, and informs discharge planning for older adults who require early follow-up to avoid readmission.

What the patterns signal for service planning

Utilization concentrated in the first weeks to months after arrival typically reflects a combination of catch-up care, reassessment, and medication reconciliation. Older adults often need comprehensive reviews of chronic disease control and screening for complications. Systems can respond by designating intake clinics or extended primary care visits to consolidate these tasks. Staffing should include clinicians with experience in geriatric syndromes, supported by pharmacists to reconcile regimens and social workers to identify barriers to adherence, transport, and follow-up.

Emergency department usage in older displaced populations frequently tracks gaps in same-day access, difficulties communicating symptoms, and uncertainty about how to navigate care pathways. Mitigation strategies include outreach with clear instructions on when and how to seek care, hotlines with rapid triage, and reservation of urgent slots in primary care and specialty clinics. Embedding community paramedicine or urgent care centers that coordinate directly with primary care teams reduces unnecessary ED visits while preserving a safety net for true emergencies.

Hospital admissions in this demographic may reflect decompensation of chronic conditions, infections, or new diagnoses uncovered during intake. Early post-discharge follow-up within 7 to 14 days is critical. Systems should ensure automatic scheduling at discharge, continuity handoffs to identified primary care clinicians, and access to home care evaluations for functional support. Medication access upon discharge, including synchronization of refill dates and financial counseling where applicable, can reduce readmissions related to therapy lapses.

Pharmacy data are particularly informative in older refugee populations. Resumption of antihypertensives, diabetes medications, anticoagulants or antiplatelets, inhaled therapies, and thyroid replacement suggests successful re-establishment of control. Conversely, lack of fills for expected therapies may indicate affordability, supply, or knowledge barriers. Proactive pharmacist outreach and refill synchronization can close these gaps. Where polypharmacy is present, structured deprescribing reviews reduce adverse effects and simplify regimens, benefiting cognition, mobility, and adherence.

Specialist referrals often increase during the intake phase to address conditions such as cardiology follow-up, endocrinology for diabetes, pulmonology for airway disease, and ophthalmology for vision impairment. Coordinated referral pathways that set expectations for timelines, provide patient education materials in native languages, and feed results back to primary care help prevent fragmentation. For patients with mobility limitations, telehealth check-ins can triage needs and reduce unnecessary travel, provided language interpretation supports are integrated.

Diagnostic testing plays a parallel role. Baseline laboratory panels and tailored imaging can recalibrate risk stratification and reset care plans. Systems should standardize intake bundles for elderly arrivals that include blood pressure evaluation, glycemic and lipid panels, renal function assessment, and where indicated, cardiac and pulmonary imaging. Attention to vaccine catch-up and infection screening complements chronic disease management and is feasible within primary care workflows when supplies and documentation protocols are ready at intake.

Navigation and communication are cross-cutting enablers. Written and verbal instructions in the patient preferred language, access to professional interpreters, and the involvement of caregivers are associated with better continuity. Appointment reminders via SMS or calls, transportation assistance, and community partnerships can further support attendance and adherence. For older adults living alone, linkage to community organizations that provide social support may be as critical as clinical care in preventing deterioration.

From a health policy perspective, documenting utilization among elderly refugees justifies targeted resource allocation. Budgets for primary care expansion, interpreter services, pharmacist time for reconciliation, and care coordination can be calibrated to the observed concentration of visits and fills in the early post-enrollment window. Hospital administrators can align discharge planning resources to expected admission patterns, while payers can streamline coverage for essential medications and supplies that prevent acute exacerbations.

Data governance and ethical considerations remain central. De-identified administrative data can guide planning while protecting privacy, but feedback loops to clinicians on aggregate patterns help adjust day-to-day workflows. Where geographic clustering of arrivals occurs, regional capacity planning for imaging, rehabilitation, and specialty follow-up can preempt bottlenecks. For older adults with cognitive impairment or limited decision capacity, systems should ensure clear consent pathways and caregiver engagement to sustain longitudinal care.

The Israeli context also offers lessons for other jurisdictions with universal coverage and integrated delivery networks. When financial barriers are minimized, the principal limiting factors shift to logistics, information, and cultural alignment. Operational investments in intake, interpretation, and medication continuity can produce outsized returns by stabilizing chronic disease management early and reducing reliance on emergency departments for non-urgent concerns. These investments are generally transferable across settings even if specific service mixes differ.

Finally, measurement should continue. As the cohort matures, tracking the trajectory of utilization from the initial surge to steady-state will indicate whether primary care continuity displaces emergency use, whether hospitalization rates decline with better chronic control, and whether medication adherence stabilizes. Stratifying these trajectories by age bands, comorbidity burdens, and social support indicators can reveal subgroups that benefit from additional outreach, such as home visits, case management, or specialized clinics for multimorbidity and frailty.

Takeaways for clinicians and systems

For clinical teams, the near-term operational steps are clear. Prepare for an initial wave of primary care consultations focused on medication reconciliation, chronic disease tuning, and referral triage. Build same-day access to absorb urgent but non-emergent needs and reduce avoidable emergency visits. Integrate pharmacists and interpreters into intake pathways, and standardize laboratory and vaccination bundles. Schedule early post-discharge follow-up for older adults admitted during the intake period, with attention to transportation and caregiver involvement.

For system leaders, use utilization signals to match capacity to need. Expand appointment slots and care coordination staffing, prioritize interpreter availability, and ensure pharmacy benefits and formularies accommodate common chronic therapies without administrative delays. In regions with concentrated arrivals, co-locate services and consider mobile clinics to reach mobility-limited seniors. Monitor refill gaps and no-show rates as leading indicators of emerging problems that can be addressed with targeted outreach.

For policymakers, the findings underscore the importance of rapid enrollment processes and clear benefit communication. Stable coverage and predictable access reduce uncertainty and support continuity for older refugees. Funding streams that recognize the front-loaded nature of service use in the first months after arrival can be time-limited and targeted, tapering as utilization normalizes. Investment in data infrastructure ensures that real-time monitoring feeds continuous improvement, supporting both humanitarian aims and health system performance.

Across all levels, a consistent thread emerges: older displaced people can reconnect to care quickly when systems anticipate their needs. The patterns described here, even absent specific numerical comparisons, provide a roadmap for aligning clinical workflows, capacity, and benefits to the realities of resettlement. With this alignment, continuity of chronic disease care, safe medication use, and appropriate use of acute services become achievable goals rather than aspirational targets.