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3 Nightmare Access block Exit block Bed blockers

Are old people taking over our hospitals?

National Symposium on Aged Care Research Professor Len Gray Practitioner, Industrialist or Community Representative? September 2003

6 Ambulance bypass episodes

Aged The regional schematic Low 950 High 1050 Residential care Hospital Subacute 40 Total pop’n 270,000 Aged ,000

9 Transfers to residential care Total permanent admissions 621 High care admissions395 Low care admissions226 Transfers from hospitals ~280 Average wait? 3 weeks Beds occupied16 % of hospital beds occupied1.6% Ratio /

10 The regional schematic Low 950 High 1050 Residential care Hospital Subacute 40 Aged Total pop’n 270,000 Aged ,000 No man’s land Interim care 16

Source: DHA 11 Residential care beds Operational June 2001 by region

12 The regional schematic 30 high care beds / 1000 Low 950 High 720 Residential care Hospital Subacute 40 Aged No man’s land Interim care 16

Source: Gray L et al (unpublished) 13 Prevalence of ADL independence Acute wards PA hospital 2003 (Pilot study 1:4 patients 65+)

14 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 ?

Inouye S et al (1999) NEJM

16 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?

Source: AIHW National Hospital Morbidity Data Cubes 19 Total hospital bed days by age group

Source: National Hospital Morbidity Data Cubes 20 Total bed day use by age group 1993 – 2001 (rate per 1000 population)

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