• Print

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.

How much activity was there for patients aged 85 years and over?

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).

Figure 1: Proportion of separations for patients aged 85 years and over by hospital sector, 2014–15

This horizontal bar chart shows sixty-one per cent of separations for patients aged 85 years occurred in public hospitals and 39% in private hospitals.

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.

Admitted patient

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.

Hospital separation

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.

Overnight separation

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.

Care type

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:

  • Acute
  • Newborn (not applicable for this spotlight)
  • Sub-acute (Rehabilitation care, Palliative care, Geriatric evaluation and management, and Psychogeriatric care)
  • Non-acute (Maintenance care)
  • Other admitted patient care.

Who used these hospital services?

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).

Figure 2: Proportion of separations for patients aged 85 and over by sex, 2014–15

This horizontal bar chart shows 55% of separations for patients aged 85 and over were for females, who account for 63% of the population in this age group.

Source: NHMD.

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).

Figure 3: Proportion of separations for patients aged 85 and over by age group and sex, 2014–15

This stacked horizontal bar chart shows a higher proportion of separations are for males than females aged 85–89 but a higher proportion of separations for patients aged 90–94 and 95–99 are for females.

Source: NHMD.

How long did patients aged 85 and over stay?

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).

Figure 4: Proportion of same-day and overnight separations for patients aged 85 and over, by hospital sector and by sex, 2014–15

This horizontal bar chart shows that 54% of private hospital separations for patients aged 85 and over were same-day, compared with 34% in public hospitals.

Source: NHMD.

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) [1]. 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).

Figure 5: Average length of stay for overnight separations for patients aged 85 and over, by hospital sector and by sex, 2014–15

This horizontal bar chart shows female patients aged over 85 spent almost 1 day longer (8.7 days) than male patients (8.0 days) for overnight separations. It also shows overnight separations for patients aged 85 and over were longer in private hospitals (9.1 days) than in public hospitals (8.1 days)

Source: NHMD.

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.

Figure 6: Proportion of lengths of stay for overnight stays for patients aged 85 and over by hospital sector, 2014–15

This grouped vertical bar chart shows 56% of overnight separations in public hospitals for patients aged 85 and over had a length of stay between 1 and 5 days compared to 46% in private hospitals. Around 20% of patients over 85 stayed 6–10 days.

Source: NHMD.

How has this activity changed over time?

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).

Figure 7: Separations for patients aged 85 and over as a proportion of all separations, 2005–06 to 2014–15

This vertical bar chart shows that between 2005–06 and 2014–15, separations for patients aged 85 and over as a proportion of all separations increased, from 4.9% to 6.8%.

Source: NHMD.

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).

Figure 8: Same-day and overnight separations for patients aged 85 and over, 2005–06 to 2014–15

This stacked vertical bar chart shows that between 2005–06 and 2014–15, same day separations for patients aged 85 and over as a proportion of all separations for patients aged 85 and over increased from 31% ( 110,910 separations) to 42% (287,933 separations).

Source: NHMD.

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).

Figure 9: Separations for patients aged 85 and over by age-group, 2005–06 to 2014–15

This stacked vertical bar chart shows that the separations for patients aged 85–89 have increased between 2005–06 and 2014–15. In 2014–15, the number of separations for people aged 85–89 outnumbered the total separations for people aged 85 and over for each year in the period 2005–06 to 2008–09.

Source: NHMD.

What type of care did patients aged 85 and over receive?

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).

Figure 10: Type of care received by patients aged 85 and over and all separations, 2014–15, per cent

This horizontal bar chart shows that acute care was the most common type of care for patients aged 85 and over. In addition, compared to all separations, a higher proportion of people aged 85 and over received Palliative care, Geriatric evaluation and management, Maintenance care and Psychogeriatric care, and Palliative care.

Source: NHMD.

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 11: Type of sub-acute and non-acute care, received by patients aged 85 and over and all separations, by hospital sector, 2014–15, per cent

This stacked horizontal bar chart shows there was a greater proportion of patients aged 85 and over receiving acute care in public hospitals compared to private hospitals. In addition, 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.

Source: NHMD.

For what conditions did patients aged 85 and over receive care?

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.

Figure 12: Proportion of separations by ICD-10-AM principal diagnosis chapter for patients aged 85 and over and all separations, 2014–15, per cent

This grouped horizontal bar chart shows about 11% 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 Injury, poisoning and certain other consequences of external causes and Diseases of the eye and adnexa for patients over 85.

Source: NHMD.

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.

Figure 13: The 20 most common 3-character principal diagnoses for patients aged 85 years and over and all separations, 2014–15, per cent

This grouped horizontal bar chart shows care involving dialysis was the most common principal diagnosis, and Care involving use of rehabilitation procedures was the second most common principal diagnosis. Compared to all separations, patients aged over 85 had a higher proportions of separations for 17 of the 20 most common principal diagnoses in 2014–15.

Source: NHMD.

What procedures did patients aged 85 years and over undergo?

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.

Figure 14: Proportion of separations by ACHI procedure chapters for patients aged 85 and over and all separations, 2014–15, per cent

This grouped horizontal bar chart shows care involving dialysis was the most common principal diagnosis, and Care involving use of rehabilitation procedures was the second most common principal diagnosis. Compared to all separations, patients aged over 85 had a higher proportions of separations for 17 of the 20 most common principal diagnoses in 2014–15.

Note: n.e.c. not elsewhere classified.

Source: NHMD.

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.

Figure 15: The 20 most common procedures reported for separations of patients aged 85 and over, 2014–15, per cent

This horizontal bar graph shows the most common procedures were Physiotherapy, followed by Occupational therapy and Social work.

Source: NHMD.

Who paid for the care of patients aged 85 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:

  • two thirds (67%, 279,399) of separations for patients aged 85 and over were publically funded—a lower proportion than for all separations (83%) (Figure 15)
  • private health insurance funded a further 19% (80,215) of separations for patients aged 85 and over, compared with 14% for all separations
  • the Department of Veterans' Affairs funded 13.5% (56,335) of separations for patients aged 85 and over, compared with 1.5% for all separations (1.5%).

In private hospitals:

  • private health insurance funded the majority (63%, 170,682) of separations for patients aged 85 and over—a lower proportion than for all separations (83%)
  • the Department of Veterans' Affairs funded 29.3% (79,808) of separations for patients aged 85 and over, compared with 4.3% for all separations (4.3%)
  • 3.0% (8,281) of separations for patients aged 85 and over were public patients—similar to the proportion for all separations (3.7%).

Figure 16: Proportion of separations by funding source and by hospital sector, patients aged 85 and over and all separations, 2014–15

This horizontal stacked bar graph shows a higher proportion of patients aged over 85 in public hospitals were funded by private health insurance and Department of Veterans’ Affairs compared to all separations. In private hospitals, a higher proportion of patients aged over 85 are funded by the Department of Veterans’ Affairs compared to all separations.

Source: NHMD.

Data source

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.


References

  1. Australian Institute of Health and Welfare (AIHW) 2016. Admitted patient are 2014–15: Australian hospital statistics. Health services no. 68. Cat. no. HSE 172. Canberra: AIHW.