Key result
Proportion of hospital discharges for patients 85 and older increased while in-hospital mortality fell ~6%.
Why the study?
The aging population is an increasing concern in Western hospital systems, and characterization of hospitalization patterns in patients aged 85 years or more in Spain was needed.
Observational (n=4,387,326)
Yes
Absolute Event Rate: 13.83% vs 14.64%
p-value: p=<0.001
Hospital discharges for patients aged 85 and older in Spain have doubled as a proportion of total discharges from 2000 to 2015, with decreasing in-hospital mortality and length of stay.
Supports expanded geriatric resources amid rising very-elderly discharges; leaves open causal mechanisms behind declining mortality and length of stay.
BACKGROUND: The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. METHODS: Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. RESULTS: There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000-2003 and 10.42% in 2012-2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85-89 years, 7.79% in those aged 90-94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000-2003 to 13.83% in 2012-2015 (p < 0.001), and mean length of stay from 9.98 days in 2000-2003 to 8.34 days in 2012-2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). CONCLUSIONS: Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.
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Fernández et al. (2021) conducted an observational in Hospitalization in very elderly patients (n=4,387,326). Time period (2012-2015) vs. Time period (2000-2003) was evaluated on In-hospital mortality (p=<0.001). Between 2000 and 2015, hospital discharges for patients aged 85 years and older in Spain increased significantly as a proportion of total discharges, while in-hospital mortality decreased from 14.64% to 13.83%.
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