Geriatric medicine: the anatomy of change

We have studied workloads and patterns of care in geriatric medicine from 1982 to 1993 in the Ulster Hospital. There was a 137% rise in admissions, a 16% reduction in domiciliary visits and a 31% increase in ward assessments. The continuing care waiting list fell to zero in 1993. The number of new outpatients rose by a factor of 8.6 between 1987 and 1993. Between 1990 and 1993 there was an increased admission rate from nursing homes and of patients suffering from respiratory system diseases. Mortality rates fell from 27.8% in 1982 to 19.3% in 1990 and to 12.1% in 1993. Mean age and sex ratios remained unchanged over the years while the average length of stay halved from 43.3 to 22.6 days between 1990 and 1993. 81% of admissions in 1993 were emergencies. Care of the elderly in hospital and the interface with general medicine are changing.