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Flat on your back or back to your flat? Sources of increased hospital services utilization among the elderly in
C Hertzman1, I R Pulcins, M L Barer
1Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Insights
The British Columbia hospital system increasingly allocated days to elderly patients with long stays. Chronic conditions like dementia and stroke sequelae drove this increase, questioning the system's response to aging populations.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Public Health Policy
Background:
- Between 1969 and 1985, the British Columbia (BC) hospital system saw a significant rise in hospital days allocated to elderly patients with prolonged stays (≥60 days).
- By 1985/86, these long-stay elderly patients constituted nearly 50% of all occupied hospital days in BC.
Purpose of the Study:
- To investigate the specific diagnoses contributing to the increased patient days among the elderly population in BC.
- To evaluate the appropriateness of the hospital system's response to the healthcare demands of an aging population.
Main Methods:
- Analysis of patient days allocated to elderly individuals with long hospital stays (≥60 days) between 1969 and 1985/86.
- Identification of key diagnoses responsible for the increase in patient days.
Main Results:
- The increase in patient days was primarily driven by a limited number of chronic conditions, notably those related to senility and senile dementia, chronic sequelae of heart disease and stroke.
- A significant portion of increased days were for patients awaiting transfer to appropriate facilities.
- Eighty percent of the increase occurred in extended care and rehabilitation beds, with 20% in acute care beds. Females accounted for 77% of the increased patient days.
Conclusions:
- The primary drivers of increased elderly patient days were chronic conditions lacking new, effective hospital treatment modalities.
- The findings raise concerns about the suitability of the current hospital system's approach to addressing the healthcare needs of BC's aging population.
Abstract:
Between 1969 and 1985, the British Columbia hospital system allocated an increasing proportion of the province's total hospital days to elderly patients who stayed for 60 days or more. By 1985/86, long stay patients accounted for almost 50% of all days. In this paper, we explore the diagnoses which contributed the greatest number of patient days of increase among the elderly as a first step in evaluating the appropriateness of this response to the pressures of an aging population. Patient days of increase were not distributed smoothly across a large number of diagnoses, but could be explained by a small number of chronic conditions. Most important were conditions related to senility and senile dementia, the chronic sequelae of heart disease and stroke, and persons awaiting admission to adequate facilities elsewhere. Eighty percent of the increases were seen in extended care and rehabilitation beds and 20% in acute care beds. Seventy-seven percent of the increased patient days were attributable to females and only 23% to males. Since the major sources of increase in patient days were not related to conditions for which new, effective hospital care modalities are available, they call into question the appropriateness of the system's response to the health care needs of the elderly population.