1. Presenter: Professor Julie Byles Research Centre for Gender Health and Ageing, University of Newcastle, NSW, Australia Email: Julie.Byles@newcastle.edu.auJulie.Byles@newcastle.edu.au

2. Hospital services use Older people make relatively high use of hospital services. Most common reasons for admission (2004-2005) were in a “general need and service category” (eg. Investigation, dialysis, rehab, waiting admission to RAC, social) 30%; circulatory diseases; neoplasms (benign/malignant tumour); digestive system diseases; and injury/external causes (for eg, falls). In 2004-2005, for persons 85+, acute care accounted for 65% of patient days (women), 69.3% (men); and rehabilitation accounted for 14.5% of patient days (women), 11.2% (men). Older women make up a larger proportion of the older population and hence have more overnight hospital stays compared to men. Source: AIHW (2007) Older Australians at a Glance, 4 th Edition, Canberra: AIHW.

3. ` Rate of hospital separations increases with age, as does the average number of days/length of stay. Projections are that when the baby boomer generation reaches older ages (85+), total separations will increase from 7 million in 2004-2005 to 11 million in 2030; and Total bed-days will almost double, from 24 million to 42 million patient days (AIHW 2007). Given the high use of hospital services by older people it is important to increase understanding of the reasons for admissions to hospital and outcomes of hospitalisation.

4. Key questions At what rate do numbers of hospitalisations increase as women age? What factors predict hospital admissions among older women in Australia? What are the patterns and trajectories of hospital use, particularly in the last year of life?

5. Australian Longitudinal Study on Women’s Health ALSWH 1921-26 cohort Baseline Survey 1 (1996) Aged 70-75 years (n= 12432) This study looks at those women who: survived to 2010 and partcipated in Survey 5, 2008, 82-87 (n= 1847)

6. Data linkage NSW APDC (New South Wales Admitted Patient Data Collection) data from the years 2000-2010. Linked to ALSWH Survey data for 1847 women resident in NSW for the entire period of study, who had not died, and who completed ALSWH Survey 5 in 2008 (age 82-87 years). Another 1283 women had record of admission to hospital in NSW between 2000 and 2010 but died before completing Survey 5.

7. Probability of 1 or more admissions 2000-2010 N = 1612 women born 1921-26 - resident NSW at all surveys, completed Survey 5 (2008) aged 82-87 <1400 (87%) with 1 or more admissions 2000-2010

8. Number of admissions 2000-2010 N = 1612 women born 1921-26 - resident NSW at all surveys, completed Survey 5 (2008) aged 82-87 <1400 (87%) with 1 or more admissions 2000-2010

9. Reasons for Hospital Admissions

10. Patterns of hospital use over time

11. Proportion of overnight hospital admissions (excluding Day Stays) for older women by patterns of hospital use

12. Proportion of Day Stay admissions for older women by patterns of hospital use

13. Implications for policy and practice A sub-population account for most of overnight hospital use most of the time :– ~ 50% of overnight use by 20% “high users” and these are the survivors!!! Need to identify factors associated with higher use – upstream and downstream, and opportunities for prevention Need to unpack different service use use for different groups, and opportunities for alternative forms of care Different pattern for day stay ~ 30% of day stay use by 20% “high users” ~ 50% of day stay use by 40% “increasing users” Need to also assess health care use by people who have died … particularly the last year of life – where most hospital use tends to occur