Queensland Government population projections (2015 edition) predict that the number of people aged 75+ will grow on average by 23 per cent every five years for the next 20 years (2016–2036). People are living longer, with a growing number experiencing multiple co-morbid conditions, resulting in an increasing demand for health services, all within a constrained fiscal environment. Statewide, Queensland emergency departments (EDs) are experiencing the highest growth in presentations by patients aged 75. This growth is more than double the statewide total increase across all age cohorts.
Older patients are known to experience long delays in the ED, which can result in poorer outcomes. In 2017, the statewide overall Emergency Length of Stay (ELOS) four-hour performance for the 75+ cohort was 51.3 per cent, which is well below the 0-16 years (83.6 per cent) and 17-74 years (72.0 per cent). Figures for those patients admitted from emergency departments to an inpatient ward (not including Short Stay Units) in 2017 demonstrate that only 26.1 per cent of patients older than 75 leave the emergency department within four hours, compared with 35 per cent (17-74years) and 41.4 per cent (0-16 years). Additionally, patients in this cohort who are admitted to hospital are also known to stay longer in an acute bed and be more likely to require rehabilitation care before being discharged home.
The pressures reflect a world-wide trend, related to both ageing populations and the increase of chronic disease in the community. With the expectation that this rate is only likely to escalate, Queensland needs to plan for caring more appropriately for this cohort of patients. The time is right to find new ways to manage the cohort of frail elderly patients who present at EDs, and who often end up languishing in acute beds in inpatient units. These patients are often in the final years of their lives and wish only to be at home with loved ones. Every day that they spend in an acute hospital bed is detracting from this goal.
