[Impact of aging on hospital caseload]

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis

Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012.

Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population size and age-gender composition – and three service components – hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios.

Results: During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022.

Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.

Has the prevalence of health care services use increased over the last decade (2001-2009) in elderly people? A Spanish population-based survey

OBJECTIVES

(1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001-2009.

STUDY DESIGN

Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n=21,058), 2003 (n=21,650), 2006 (n=29,478) and 2009 (n=22,188). We included responses from adults aged 65 years and older.

OUTCOME MEASURES

The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models.

RESULTS

The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P<0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39-1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27-1.61; men: OR 1.71, 1.49-1.97).

CONCLUSIONS

The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.

[The comorbidity in primary care]

As patients live longer, and more illnesses become chronic, comorbidity rates increase. This increase shows in attended morbidity registers, and its importance is revealed by the use of services, treatments, the survival rates and the patients life quality. A frequent coexistence of illnesses, such as diabetes and depression, increases the cost of primary care and emergency treatments and the number of hospital admissions; increases the probability of cardiovascular risk and non-adherence to treatment and diet; causes a perception of poor physical and mental health and, on the whole, increases global costs. The annual mortality rate shoots up when anemia and cardiovascular or kidney failure occur. Mental comorbidity has a greater effect on the patients perception of their life quality than physical comorbidity. Comorbidity increases the number of hospital admissions which could have been prevented, as well as the avoidable complications related to them. Suicidal thoughts occur more frequently in patients suffering from chronic obstructive pulmonary disease (COPD) than in those suffering from other chronic organic illnesses. In patients suffering from atrial fibrillation, the risk of acute coronary crisis increases as they age and the comorbidity increases the use of angiotensin-converting enzymes (ICAE), antidepressant drugs and the visits to the psychiatrist.

[Evaluation of the satisfaction with a care coordination program between Primary Care and general internists]

OBJECTIVES

To evaluate the level of knowledge, participation and satisfaction with a continuity of care program between Primary Care and a group of general internists, and to analyse the most frequent reasons for consulting.

MATERIAL AND METHODS

Cross-sectional study including all primary care physicians from 10 Family Practice Care Centres using a questionnaire containing these objectives.

RESULTS

Eighty-three family physicians (92.2%) answered the survey. All physicians knew of the collaboration program and had also participated. The most common clinical problems seen were: patients with multiple health problems(26.5%), cardiovascular risk factors (16.8%) and diagnosis of the asthenia syndrome (141%), with these three problems obtaining the best evaluation in the satisfaction survey. Almost all (98.8%) of the family physicians were satisfied with the program.

CONCLUSIONS

Our continuity care program was very well evaluated in the satisfaction survey by family physicians. The participation index was very high and the clinical problems most frequently consulted and best evaluated were those that traditionally have been seen by the internists.

[Short-Stay Medical Unit, an alternative to conventional hospitalization]

BACKGROUND

The Short-Stay Medical Unit (SSMU) is an alternative to conventional hospitalization. This study has aimed to analyze the evolution of admissions and duration of stay in a SSMU, to outline the characteristics of the patients while studying their relationship to length of time spent in the unit and their destination on discharge as well as to assess how appropriately their cases were resolved.

MATERIAL AND METHODS

A descriptive study was carried out (2000-2005), analyzing their age, sex, destination on discharge and main diagnosis as well as the evolution of admissions and length of stay over this period. In order to determine how appropriately each case was resolved, length of stay and destination on discharge were considered. The data were analyzed using the SPSS program.

RESULTS

During the study period there was an increase in the number of admissions and in length of stay. The average age of the 7,618 patients was 70.6 +/- 16.9 years and the average stay 2.7 +/- 1.4 days. One of the most frequent diagnoses was chronic obstructive pulmonary disease (COPD) (15.9%). On discharge, 85.9% of patients were sent home. A total of 76.4% of cases were resolved satisfactorily, with significant statistical differences related to age, diagnosis and number of diagnoses.

CONCLUSIONS

A progressive increase in admissions and length of stay was observed. Ninety percent of the cases of the younger patients were resolved satisfactorily, this decreasing to 72% for older patients. The number of diagnoses, specific diagnoses and age caused some difficulty in reaching an appropriate resolution.

[Influence of functional dependence on the case mix in a geriatric unit]

OBJECTIVE

To determine the influence of pre-admission functional status on the case mix in a geriatric unit, after adjustment by the diagnosis-related groups (DRG) patient classification system.

MATERIAL AND METHODS

We performed a retrospective observational study in patients admitted to the geriatric unit of a general hospital over a 2-year period. Patients with a length of stay of less than 2 days and transfers from other medical services and hospitals were excluded. The following data were obtained from the minimum data set and from chart review: age, sex, place of residence before admission, Charlson comorbidity index, pre-admission functional status and mobility, cognitive status, length of hospital stay, rate of in-hospital mortality, and the DRG (and DRG weight) for each patient.

RESULTS

A total of 1065 patients were included in this study. The mean age was 84 years (64-102), and 64% were women. Patients with lower functional status were more often female (67.1 vs 55.8%; P< .01), more frequently admitted from nursing homes (35.8 vs 14.7%; P< .01) and had higher mortality (19.3 vs 10.1%; P< .01). These patients also had a higher mean length of stay (12.7 vs 11.9), higher comorbidity scores (P< .01), greater cognitive impairment (P< .01) and higher DRG weight (P=.03). Once the more frequent DRG were reviewed, patients who were dependent had a greater number of respiratory infections and renal problems and had fewer cerebrovascular diseases.

CONCLUSIONS

Some clinical characteristics differ in patients with functional dependence. This finding could influence the clinical management of medical services that treat more dependent patients.

[Functional ability and social-care problems of the elderly in the Cáceres health area]

OBJECTIVE

To describe the social environment and to identify the health problems and the functional and mental ability of the elderly in the community.

DESIGN

Cross-sectional, observational study by means of a questionnaire.

PATIENTS

228 people over 71 and not living in an institution.

SETTING

Cáceres Health Area.

MAIN MEASUREMENTS

Questionnaire on social and demographic details, main pathologies, social assessment (Gijón scale), functional assessment (Barthel and Lawton-Brody scales), mental assessment (Pfeiffer test), geriatric problems and visits from health professionals.

RESULTS

67% of the 228 people in the sample were women, with an average age of 79. Comorbidity, present in over 70% of the elderly, was significantly related to multi-medication, falls, hospital admission, depression and insomnia. The most common social and family situation was of a person living with his/her partner (38.3%; CI, 6.31) or children, in a dwelling with architectural barriers (43.0%; CI, 6.43), with a good relationship to his/her social surroundings (61.0%; CI, 6.33). The Barthel test showed a significant relationship with all the geriatric problems declared. The Pfeiffer test showed a relationship with falls (t=3.10; P=.00214), with hearing problems (t=1.98; P=.048), with incontinence (t=3.59; P=.0040) and constipation (t=2.64; P=.0086). The Lawton-Brody test was related, in women, with falls (t=4.27; P=.00034), admissions (t=2.02; P=.044), constipation and sight and hearing problems; and in men, with depression and incontinence.

CONCLUSIONS

Elderly people in the Cáceres Health Area showed good functional ability in their basic daily tasks, less ability in instrumental activities and high comorbidity.