Abstract
BackgroundThe 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.MethodsRetrospective 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.ResultsThere 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%).ConclusionsDischarges 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.
Highlights
The aging population is an increasing concern in Western hospital systems
The proportion of patients that died during hospital admission was calculated as the number of discharges of patients aged 85 years or more who died during their hospital stay, divided by the number of annual discharges in patients aged 85 years or more
We made a linear graphic with the known annual proportion of hospitalizations due to pneumonia and cholelithiasis between 2000 and 2015 (Fig. 1), which shows stability throughout the study period, with an annual percentage change (AAPC) of only 0.67 and − 0.41% respectively; we considered pneumonia and cholelithiasis to show a stable trend during the study period, which will probably hold in the years to come
Summary
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. According to the NSI, people aged 85 years or older accounted for 3.2% of the total population in Spain in 2019 [1]. Trends show increasingly frequent discharges at all ages; this pattern is especially pronounced in the elderly population [5]. Hospital care for this population segment involves special challenges, including more frequent clinical complications during the hospital stay and patients who have cognitive and functional impairment. These challenges require tailored efforts from hospital staff, which sometimes have a limited benefit for the patient
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