Who should provide hospital care of elderly people?

[Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group]

INTRODUCTION

Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible.

METHOD

Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments.

RESULTS

A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05.

CONCLUSIONS

AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years.

[Efficiency of acute geriatric units in Spain hospitals]

OBJECTIVES

To review published data from Spanish hospitals in which comparisons had been made between the mean length of stay in patients admitted to acute geriatric units (AGU) and those admitted to other departments using the diagnosis-related groups (DRG) classification system and to describe our own experience.

MATERIAL AND METHODS

The Spanish reports collected in a previous systematic review were reviewed. The case mix of our hospital was added by analyzing episodes in patients older than 74 years old discharged during a 24-month period and included in the most frequent DRGs. The length of stay in patients admitted to the AGU was compared with that in the remaining medical departments in the hospital and with the standard average stay in the corresponding autonomous region.

RESULTS

Data were obtained from five Spanish general hospitals. The comparison revealed that the mean length of stay in the AGU was 8-19% shorter than that of similar patients in the other medical departments of the same hospitals. In one hospital, the reduction in the mean length of stay was 21% in patients older than 80 years. In three of the four hospitals where comparisons with the standard were performed, the mean length of stay in the AGU was lower for most of the DRGs, showing reductions of 7-9%.

CONCLUSIONS

These results allow us to conclude that, based on the commonly used patient classification and coding system, Spanish AGUs are more efficient than the remaining medical services in the acute hospitalization of elderly patients in our setting.

Age-Related Geriatric Medicine: Relevance of Special Skills of Geriatric Medicine to Elderly People Admitted to Hospital as Medical Emergencies

This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focussed on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care.

Psychogeriatric hospitalization: terminable or interminable?

This paper takes issue with the stereotype of psychogeriatric patients in the general hospital using beds unnecessarily. With appropriate organization of services involving integrated teamwork, comprehensive patient assessment, early discharge planning and liaison with community resources, a positive outcome and early discharge was achieved with the majority of a group of psychogeriatric patients.

Geriatric versus general medical wards: comparison of patients' behaviours following discharge from an acute care hospital

The objective of this study was to explore, from a nursing perspective, the effectiveness of geriatric wards in preparing elderly patients for discharge from an acute care hospital. A convenience sample of 40 patients aged 70 years or older was obtained from three geriatric medical wards and two general medical wards of a large British teaching hospital. Data were collected immediately prior to discharge, and after 6 and 13 weeks following discharge. No meaningful differences were found between the two patient-groups in their ability to cope with activities of daily living following discharge. The majority of deaths and/or hospital readmissions occurred within 6 weeks of discharge. A major concern identified in both groups was patients' lack of knowledge about medications and their side-effects. A need for more effective teaching programmes for elderly patients was identified.

Hospital length of stay of frail elderly patients. Primary care by general internists versus geriatricians

Hospitalized patients in a medical diagnosis-related group (DRG) who were cared for by physicians in a division of Geriatric Medicine (geriatric group) were compared with a control group drawn from a stratified random sample of patients cared for by general internists (internist group) in the same hospital. Despite an older age, longer predicted length of stay, and higher DRG reimbursement, the geriatric group patients had a significantly shorter length of stay (8.8 vs 15.8 days; P less than 0.05) than the internist group. A shorter length of stay for the geriatric group was noted in each of five subgroups, sorted by admission and discharge status. Comparison to national data reveals that, despite the shorter length of stay in the geriatric group, length of stay data used by hospitals for management purposes would still classify the patients of the geriatrics group as "revenue losers" under the Medicare hospital reimbursement system.

Copper and zinc levels in "healthy" and "sick" elderly

Healthy elderly as a group have a wider range for serum copper, ceruloplasmin, and serum zinc than the adjusted ranges for the laboratory. In disease serum copper and/or ceruloplasmin act as acute-phase reactants in vascular disease, inflammation, and malignancy. Serum zinc values likewise are affected by the presence of inflammation and malignancy. The reported low level of copper in patients with osteoporosis was not confirmed by the present study. Neither was there any evidence found for zinc deficiency in patients with dementia.