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This spotlight report looks at the admitted patient (see Box 1) care provided for the oldest of patients in Australian hospitals in 2014–15. It presents information on the amount of activity there was for patients aged 85 years and over and how this has changed over time. It includes information on who used the hospital services, the length of stay in hospital, the overall type of care provided, the types of conditions patients received care for, the type of procedures undergone by the patients, and who funded the hospital stay.
More information on admitted patient care in Australian hospitals can be found in Admitted patient care 2014–15: Australian hospital statistics.
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In 2014–15, people aged 85 and over (who make up 2% of the population) accounted for 7% (690,658) of all hospital separations (10,150,367). Sixty-one per cent (418,347) of these separations occurred in public hospitals and 39% (272,311) in private hospitals (Figure 1).
Source: National Hospital Morbidity Database (NHMD).
Box 1: Understanding admitted patient care terms
This spotlight draws on data from the National Hospital Morbidity Database (NHMD). The NHMD is based on data provided to the Australian Institute of Health and Welfare (AIHW) by state and territory health authorities for the National Minimum Data Set (NMDS) for Admitted patient care. It contains episode-level records from admitted patient morbidity data collection systems in Australian public and private hospitals and include administrative, demographic and clinical data.
An admitted patient is a patient who undergoes a hospital's formal admission process. Statistics on admitted patients are compiled when an admitted patient completes an episode of admitted patient care and 'separates' from the hospital. This is because most of the data on the use of hospitals by admitted patients are based on information provided at the end of the patients' episodes of care, rather than at the beginning. The length of stay and the procedures carried out are then known and the diagnostic information is more accurate.
A hospital separation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation). 'Separation' also means the process by which an admitted patient completes an episode of care by being discharged, dying, transferring to another hospital or changing type of care.Same-day separation
A same-day separation occurs when a patient is admitted to and separated from the hospital on the same date.
An overnight separation occurs when a patient is admitted to and separated from the hospital on different dates.
Length of stay
Length of stay is measured using 'patient days'. The length of stay for an overnight patient is calculated by subtracting the date the patient is admitted from the date of separation and deducting days the patient was on leave (for example, went home for part of a day with the intention of return). A same-day patient is allocated a length of stay of 1 day.
The care type describes the overall nature of a clinical service provided to an admitted patient during an episode of care. The care type can be classified as:
The majority of separations for patients aged 85 and over (55% or 380,202) were for females (who account for 63% of the population in this age group) (Figure 2).
Patients aged 85–89 (who make up 64% of the population aged 85 and over) accounted for two-thirds of these separations (67%, 461,426). For patients aged over 100 there were 2.7 times as many female separations (2,686) compared to male separations (999) (Figure 3).
Forty two per cent (287,933) of separations for patients aged 85 years and over were same-day separations (see Box 1) in 2014–15. A greater proportion of separations for males aged 85 and over were on a same-day basis 47% (144,961) compared with females 38% (142,972) during 2014–15.
More than half 54% (147,294) of private hospital separations for patients aged 85 and over were same-day, compared with 34% in public hospitals (140,639) (Figure 4).
In 2014–15, the average length of stay for overnight separations (see Box 1) for patients aged 85 and over was 8.4 days, about three days longer than the average for all overnight separations (5.5 days) . Female patients (8.7 days) spent almost 1 day longer than male patients (8.0 days) for overnight separations. Overnight separations for patients aged 85 and over were longer in private hospitals (9.1 days) than in public hospitals (8.1 days) (Figure 5).
In 2014–15, more than half (56%, 156,465) of overnight separations in public hospitals for patients aged 85 and over had a length of stay between 1 and 5 days (Figure 6). In contrast, private hospital overnight separations for patients aged 85 and over lasting between 1 and 5 days represented less than half (46%, 57,534) of overnight separations.
The total number of separations for patients aged 85 and over almost doubled from 359,472 in 2005–06 to 690,658 in 2014–15.
Separations for patients aged 85 and over increased as a proportion of all separations, from 4.9% in 2005–06 to 6.8% in 2014–15 (Figure 7).
As the numbers of separations for patients aged 85 and over increased, the mix of same‑day and overnight separations changed.
In 2005–06, same-day separations represented 31% (110,910) of all separations for patients aged 85 and over, increasing to 42% (287,933 separations) in 2014–15. The proportion of separations that were overnight fell, even though they increased in volume over the period (Figure 8).
In 2014–15, the number of separations for people aged 85–89 outnumbered all separations for people aged 85 and over for each year in the period 2005–06 to 2008–09 (Figure 9).
In 2014–15, Acute care was the most common type of care (see Box 1) received by patients aged 85 and over (86%, 594,544), as it was for all separations for all ages (94%, 9,534,700) (Figure 10). Examples of acute care include curing illness or providing definitive treatment of an injury, and performing surgery or diagnostic or therapeutic procedures.
Fourteen per cent of separations for patients aged over 85 received sub-acute and non-acute care—9.0% were for Rehabilitation care (62,001 separations), 3.7% were for Geriatric evaluation and management, Maintenance care and Psychogeriatric care (25,265 separations), and 1.3% were for Palliative care (8,841) (Figure 10).
In 2014–15, there was a greater proportion of patients aged 85 and over receiving acute care in public hospitals (88%, 368,977) compared to private hospitals (83%, 225,567).
In private hospitals, Rehabilitation care (16.2%) was the second most frequent type of care received by these patients, and in contrast, accounted for 4.3% of the care received in public hospitals.
In public hospitals, Geriatric evaluation and management, Maintenance care and Psychogeriatric care together represented 5.7% of the care received by patients aged 85 and over, compared to 0.5% in private hospitals (Figure 11).
Figure 12 illustrates the ten most common disease groups reported as the patient's principal diagnosis using ICD-10-AM (Box 2) for which patients aged 85 and over received care in hospital.
For patients aged 85 and over, the most common ICD-10-AM principal diagnosis chapter was Factors influencing health status and contact with health services (26.3%, 181,677 separations), which was also the most common ICD-10-AM principal diagnosis chapter for all separations (27.7%). This chapter includes care involving dialysis, the use of rehabilitation procedures, radiotherapy, chemotherapy and palliative care.
About 10.8% (74,814 separations) of patients aged 85 and over had a principal diagnosis in the ICD-10-AM chapter Diseases of the circulatory system, compared with 4.8% for all separations. There were also higher proportions of separations for patients aged 85 and over for Injury, poisoning and certain other consequences of external causes (68,155 or 9.9% compared with 6.4% for all separations) and Diseases of the eye and adnexa (48,269 or 7.0% compared with 3.8% for all separations).
Box 2: What are the principal diagnosis and ICD-10-AM?
The principal diagnosis is the diagnosis established after study to be chiefly responsible for occasioning the patient's episode of admitted patient care.
In 2014–15, principal diagnoses were reported using the Eighth edition of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). ICD-10-AM groups together similar conditions, organised in a hierarchy of chapters, subchapters and specific categories.
In 2014–15, the top 20 principal diagnoses (at a more detailed level, see Box 2) for separations for patients aged 85 and over represented 51% (349,644) of all separations for this age group. Care involving dialysis was the most common principal diagnosis, with 76,678 separations (11.1%); Care involving use of rehabilitation procedures 63,890 separations (9.3%) was the second most common principal diagnosis. Figure 13 presents the proportion of separations for the 20 most common principal diagnoses for those aged 85 and over compared with all hospital separations.
In 2014–15, 72% (1,080,473) of procedures for patients aged 85 and over were Non‑invasive, cognitive and other interventions n.e.c. (such as diagnostic, therapeutic, anaesthesia, pharmacotherapy and allied health interventions), compared with 53% (10,867,197) of procedures for all patients (see Box 3). Dermatological and plastic procedures (5.1%, 77,040) and Procedures on eye and adnexa (4.1%, 61,816) were also proportionally more common for patients aged 85 and over compared with all patients (Figure 14).
Box 3: Understanding the classification of hospital procedures
A procedure is a clinical intervention that is surgical in nature, carries an anaesthetic risk, requires specialised training and/or requires special facilities or services available only in an acute care setting. Procedures therefore encompass surgical procedures and non-surgical investigative and therapeutic procedures, such as X-rays. Patient support interventions that are neither investigative nor therapeutic (such as anaesthesia) are also included.
One or more procedures can be reported for each hospital admission, but procedures are not undertaken for all admissions, so only some records include information on procedures.
In 2014–15, procedures were reported for hospital patients using the Eighth edition of the Australian Classification of Health Interventions (ACHI) that groups together similar interventions.
The ACHI classification is divided into 20 chapters by anatomical site, and within each chapter by a 'superior' to 'inferior' (head to toe) approach. These subchapters are further divided into more specific procedure blocks, ordered from the least invasive to the most invasive. The blocks, which are numbered sequentially, group the very specific procedure information.
Note: n.e.c. not elsewhere classified.
Examining specific procedures, in 2014–15, 51% (758,866) of procedures for patients aged 85 and over were allied health interventions (such as social work, physiotherapy, occupational therapy, dietetics and diabetes education), compared with 21% for all separations. The most common allied health intervention was Physiotherapy, followed by Occupational therapy and Social work (Figure 15). Sedation and General anaesthesia, which are companion procedures for many other procedures, together accounted for 9.3% (139,446) of procedures for patients aged 85 years and over.
In 2014–15, public and private hospitals had different patterns of funding for separations for patients aged 85 and over (Figure 16).
In public hospitals:
In private hospitals:
These data are from the National Hospital Morbidity Database (NHMD). For more information on the data drawn from the NHMD, please refer to Admitted patient care 2014–15: Australian hospital statistics.
Two NHMD data items—Care type and Additional diagnosis—capture information on palliative care. In this spotlight and the Admitted patient care series of reports Palliative care refers to separations with a Care type of Palliative care. More detailed information on the provision of palliative care is available in the AIHW's online Palliative care services in Australia publication which includes both separations with a Care type of Palliative care and/or an Additional diagnosis of Palliative care.