EXTENDED HOSPITAL STAYS WITH INCREASING AGE - THE IMPACT OF AN ACUTE GERIATRIC UNIT

Objectives: To examine the association between increasing age and exte nded length of hospitalisation, and the impact of an acute geriatric u nit on this association. Design: Retrospective analysis of concurrentl y collected data of patients admitted to three general medical units, one of which was an acute geriatric unit.Setting: Alfred Hospital, Mel bourne (a tertiary referral teaching hospital), between 1 July 1993 to 30 June 1994. Patients: Those classified into the same diagnosis-rela ted groups (DRGs) as the 15 most common DRGs of the acute geriatric un it. Outcome measure: Incidence of patients with extended lengths of st ay (''high outliers''), analysed by age, medical unit and DRG. Results : Of 3499 patients discharged from the hospital with the 15 study DRGs , 303 patients (8.6%) were from the acute geriatric unit, and 274 and 300 patients (7.8% and 8.5%) were from the two other general medical u nits, respectively. Patients in the acute geriatric unit were signific antly older (median age group, 75-79; age range, 18-98) than patients in all other hospital units (median age group 60-94; age range, 18-97) (P<0.0001). Analysis of patients with respiratory and cardiovascular DRGs admitted to all general medical units compared with specialty uni ts showed this age discrepancy was even more marked for patients aged over 85. There was an increased likelihood (P<0.001) of an extended le ngth of stay for patients aged over 55. The incidence of high outliers for comparable DRGs was lower for patients cared for by the acute ger iatric unit, compared with general medical units. In the acute geriatr ic unit, unlike the overall trend, the proportion of high outliers did not increase with age. Conclusions: The specialised management of acu te geriatric medical units can counteract the trend towards increased incidence of high outliers with increasing age, despite significantly older patients.