Preoperative assessment and postoperative management of the elderly surgical patient

Use of inpatient hospital services by people aged 90-99 years

OBJECTIVE

To examine the use of inpatient hospital services by people aged 90-99 years.

DESIGN

Retrospective case note review.

SETTING

Flinders Medical Centre, a 516-bed university teaching hospital in Adelaide, South Australia.

PATIENTS

All patients aged 90-99 years on the separation register for 1995.

MAIN OUTCOME MEASURES

Patient demographic characteristics, principal diagnosis, length of hospital stay and outcome, including destination at discharge.

RESULTS

In 1995, 317 separations involved 214 patients aged 90-99 years; 148 patients (69%) were admitted to hospital once, 43 (20%) twice and 23 (11%) three times or more. In 54% of separations, patients came from the community, and these were less likely to be emergency admissions (72%) than were admissions from hostels (87%) and nursing homes (93%). Patients had a wide range of acute medical and surgical problems and a median of five documented comorbidities. Patients survived to leave hospital in 290 separations (91%) and returned directly to their previous living circumstances in 212 (67%). Median hospital stay was 5.0 days, and in 25% of separations stay was one day or less. Patients admitted under the care of geriatricians had more emergency admissions (98%) and longer mean hospital stays (8.9 days) than those admitted under surgeons (69%; 5.9 days) or other physicians (66%; 5.0 days).

CONCLUSION

Despite the acute nature of their illnesses and their multiple medical problems, most hospitalised nonagenarians in this study returned directly to their previous living circumstances after short hospital stays.