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Night
mar
e
Access block
Exit block
Bed blockers
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Are old people taking over our
hospitals?
Are old people taking over our
hospitals?
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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
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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
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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
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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
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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
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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
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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
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Source: Gray L et al (unpublished) 13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
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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
?
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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
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Are old people taking over our
hospitals?
Are old people taking over our
hospitals?
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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
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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+
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