ABSTRACT
OBJECTIVES: To examine the association between increasing age and extended length of hospitalisation, and the impact of an acute geriatric unit on this association. DESIGN: Retrospective analysis of concurrently collected data of patients admitted to three general medical units, one of which was an acute geriatric unit. SETTING: Alfred Hospital, Melbourne (a tertiary referral teaching hospital), between 1 July 1993 to 30 June 1994. PATIENTS: Those classified into the same diagnosis-related groups (DRGs) as the 15 most common DRGs of the acute geriatric unit. OUTCOME MEASURE: Incidence of patients with extended lengths of stay ("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 units, respectively. Patients in the acute geriatric unit were significantly older (median age group, 75-79; age range, 18-98) than patients in all other hospital units (median age group, 60-64; age range, 18-97) (P < 0.0001). Analysis of patients with respiratory and cardiovascular DRGs admitted to all general medical units compared with specialty units showed this age discrepancy was even more marked for patients aged over 85. There was an increased likelihood (P < 0.001) of an extended length of stay for patients aged over 55. The incidence of high outliers for comparable DRGs was lower for patients cared for by the acute geriatric unit, compared with general medical units. In the acute geriatric unit, unlike the overall trend, the proportion of high outliers did not increase with age. CONCLUSIONS: The specialised management of acute geriatric medical units can counteract the trend towards increased incidence of high outliers with increasing age, despite significantly older patients.
Subject(s)
Acute Disease/therapy , Geriatrics , Hospital Units , Length of Stay , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Diagnosis-Related Groups , Health Services for the Aged/organization & administration , Hospital Units/organization & administration , Hospitals, Teaching , Humans , Middle Aged , Outcome Assessment, Health Care , Patient Discharge , Retrospective Studies , VictoriaABSTRACT
Sleep complaints are common in the elderly, and are often related to physiological changes with ageing, or secondary to illness and drug therapy. Primary sleep disorders, such as sleep apnoea and movement disorders, are also common. Management should be specific to the problem. Attention to underlying factors and sleep hygiene, as well as reassurance and education about age-related sleep changes, will often be sufficient. Hypnotics, which usually offer only temporary symptomatic relief, may be counterproductive, and should be prescribed only in the short term, except in limited specific cases. Short-acting benzodiazepines (e.g., temazepam or oxazepam), or possibly zopiclone, are currently the drugs of choice.
