Geographical variations in unnecessary hospitalization of the elderly: the effects of local conditions

Three hundred and fifty-three elderly patients hospitalized in acute-care general wards in Tel Aviv and Jerusalem were studied to check whether their continued hospitalization was medically justified. Of these, 53 (15%) were found not to be in need of acute hospital care, the proportion being significantly higher in Jerusalem (20%) than in Tel Aviv (12%). The major contribution to the overstays in Jerusalem was prolonged hospitalizations of patients in need of custodial care. There was also a significant association between physical and behavioral impairment and patient overstay in both cities. Our findings suggest that hospital overstays could be reduced by the creation of an intermediate level of care for patients with placement problems following acute hospitalization.