1. 2 3 Nightmare Access block Exit block Bed blockers

1

2

3

Night

mar

e

Access block

Exit block

Bed blockers

Are old people taking over our

hospitals?

Are old people taking over our

hospitals?

National Symposium on Aged Care Research

Professor Len GrayPractitioner, Industrialist

or Community Representative?

National Symposium on Aged Care Research

Professor Len GrayPractitioner, Industrialist

or Community Representative?

September 2003

6

Ambulance bypass episodes

Ambulance bypass episodes

0

100

200

300

400

500

600

Jul-9

8

Sep-9

8

Nov-9

8

Jan-

99

Mar

-99

May

-99

Jul-9

9

Sep-9

9

Nov-9

9

Jan-

00

Mar

-00

May

-00

Jul-0

0

Sep-0

0

Nov-0

0

Jan-

01

Mar

-01

May

-01

0

10

20

30

40

50

60

70

80

90

100

All metro

RMH

8

1000

Aged 65+500

The regional schematic

The regional schematic

Low 950

High 1050

Residential careHospital

Subacute40

Total pop’n 270,000 Aged 70+ 24,000

9

Transfers to residential care

Transfers to residential care

• Total permanent admissions 621• High care admissions 395• Low care admissions 226• Transfers from hospitals ~ 280• Average wait? 3 weeks• Beds occupied 16 • % of hospital beds occupied 1.6%• Ratio / 1000 70+ 0.67

10

The regional schematic

The regional schematic

Low 950

High 1050

Residential careHospital

Subacute40

Aged 65+500

Total pop’n 270,000 Aged 70+ 24,000

No man’s land

Interim care16

Source: DHA 11

Residential care beds Operational June 2001 by region

Residential care beds Operational June 2001 by region

0

20

40

60

80

100

120

Pla

ces /

1000

pop

n. 7

0+

CACPLOWHIGH

12

The regional schematic 30 high care beds / 1000

The regional schematic 30 high care beds / 1000

Low 950

High 720

Residential careHospital

Subacute40

Aged 65+500

No man’s land

Interim care16

Source: Gray L et al (unpublished) 13

Prevalence of ADL independence

Acute wards PA hospital 2003(Pilot study 1:4 patients 65+)

0% 10% 20% 30% 40% 50%

% independent

mobility in bed

transfer

locomotion

eating

toilet use

personal hygiene

14

What can be prevented?What can be prevented?

Delirium

Pressure ulcers

Weakness & immobility

Incontinence

Loss of self care capacity

Depression & poor motivation

Carer abandonment / placement

Need for formal restorative care

?

Inouye S et al (1999) NEJM 340 9 669-76

16

What might industry want?

What might industry want?

• Ready-made solutions to unexpected issues– evidence based, feasible for implementation, rapid

effect, cheap.• Forecasting of emerging issues & advice

around appropriate responses• Robust advice based on international

standard evidence that is locally applicable & preferably validated

• Resources to conduct appropriate investigations / research

17

Are old people taking over our

hospitals?

Are old people taking over our

hospitals?

Source: AIHW National Hospital Morbidity Data Cubes 19

Total hospital bed days by age group 1993 - 2001

Total hospital bed days by age group 1993 - 2001

0%

20%

40%

60%

80%

100%

93-4 94-5 95-6 96-7 97-8 98-9 99-00 00-01 '01-2

65+0-64

Source: National Hospital Morbidity Data Cubes 20

Total bed day use by age group

1993 – 2001 (rate per 1000 population)

Total bed day use by age group

1993 – 2001 (rate per 1000 population)

0

2000

4000

6000

8000

10000

12000

93-4 94-5 95-6 96-7 97-8 98-9 99-00 00-01 '01-2

0-64

65-69

70-74

75-79

80-84

85+

21

22