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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Source: Gray L et al (unpublished) 13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
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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
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