The impact of an ageing population on the required hospital capacity: results from forecast analysis on administrative data

European Geriatric Medicine - 2019
Koen Van den Heede1, Nicolas Bouckaert1, Carine Van de Voorde1
1Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium

Tóm tắt

Evaluate the impact of population ageing on the required hospital capacity. As the general population is ageing, the hospital population is also ageing. Additional capacity needs can initially be counterbalanced by reductions in length of stay. Population ageing starts to peak from 2030 with additional hospital capacity needs: inpatient days (+ 21.9%) and hospital beds (+ 21.1%). Investments in hospital alternatives as well as in geriatric expertise within hospitals are required to deal with the ageing population. In this study, we evaluate the impact of population ageing on the required hospital capacity. We used hospital discharge (years 2003–2014) and population data to estimate the required hospital capacity by 2025 for older inpatients (≥ 75 years) taking into account population changes and trends in hospital admission rates and length of stay. In addition, we developed an alternative scenario to evaluate the impact of accelerated ageing based on the peaks in population ageing from 2030 onwards. The number of inpatient stays for our study population is expected to increase from 478,027 in 2014 to 590,313 in 2025 (+ 23.5%). The average length of stay is expected to decrease by 18.4% (− 2.3 days). As a consequence, the number of inpatient days and the required bed capacity will only increase by 42,709 days (+ 0.7%) and 72 beds (+ 0.4%), respectively. The accelerated ageing scenario shows that the increase between 2014 and 2025 is more pronounced for inpatient stays (+ 50.5%), inpatient days (+ 21.9%) and hospital beds (+ 21.1%). Ageing will, if no drastic policy actions are taken, impact the required hospital capacity. This can initially (by 2025) be more or less controlled by further reductions in length of stay. From 2030, it is expected that the required hospital bed capacity will increase exponentially with a pronounced shift between general acute care beds towards geriatric and chronic care beds. If policy makers want to revert this trend, substantial investments in hospital alternatives will be required.

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Tài liệu tham khảo

United Nations (2017) Ageing. http://www.un.org/en/sections/issues-depth/ageing/

WHO (2015) World report on ageing and health. World Health Organization, Geneva

Organization for Economic Co-operation and Development (OECD) (2004) Ageing societies and the looming pension crisis. OECD, Paris

Deschodt M, Claes V, Van Grootven B, Van den Heede K, Flamaing J, Boland B, Milisen K (2016) Structure and processes of interdisciplinary geriatric consultation teams in acute care hospitals: a scoping review. Int J Nurs Stud 55:98–114

Paulus D, Van den Heede K, Gerkens S, Desomer A, Mertens R (2013) Development of a national position paper for chronic care: example of Belgium. Health Policy 111:105–109

European Union of Medical Specialists–Geriatric Medicine Society (UEMS-GMS) (2008) Geriatric medicine definition in English, German, French, Dutch, Slovakian, Lithuanian, Hungarian, Swedish and Bulgarian, http://uemsgeriatricmedicine.org/UEMS1/dok/geriatric_medicine_definition.pdf

Wise J (2018) Number of older people with four or more diseases will double by 2035, study warns. BMJ 360:k371

Oo MT, Tencheva A, Khalid N, Chan YP, Ho SF (2013) Assessing frailty in the acute medical admission of elderly patients. J R Coll Physicians Edinb 43:301–308

Deschodt M, Wellens NI, Braes T, De Vuyst A, Boonen S, Flamaing J, Moons P, Milisen K (2011) Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Exp Res 23:421–426

Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553

Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F (2009) Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 338:b50

Fox MT, Sidani S, Persaud M, Tregunno D, Maimets I, Brooks D, O’Brien K (2013) Acute care for elders components of acute geriatric unit care: systematic descriptive review. J Am Geriatr Soc 61:939–946

Pallin DJ, Espinola JA, Camargo CA Jr (2014) US population aging and demand for inpatient services. J Hosp Med 9:193–196

Vandresse M, Duyck J, Paul J-M (2017) Demographic forecasts 2016-2060, population and households. Demographic forecasts. Federal Planning Bureau and Statistics Belgium, Brussels

Van de Voorde C, Van den Heede K, Beguin C, Bouckaert N, Camberlin C, de Bekker P, Defourny N, De Schutter H, Devos C, Gerkens S, Grau C, Jeurissen P, Kruse FM, Lefèvre M, Lievens Y, Mistiaen P, Vaandering A, Van Eycken E, van Ginneken E (2017) Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services. KCE Reports. Belgian Health Care Knowledge Centre (KCE), Brussel

HayGroup (2015) Developing a Health Care Capacity Plan for Ontario—“Proof of Concept”: report submitted to: The Ontario Hospital Association. Toronto, Ontario

Kwok CL, Lee CK, Lo WT, Yip PS (2016) The contribution of ageing to hospitalisation days in Hong Kong: a decomposition analysis. Int J Health Policy Manag 6:155–164

Toh HJ, Lim ZY, Yap P, Tang T (2017) Factors associated with prolonged length of stay in older patients. Singapore Med J 58:134–138

Nationale raad voor Ziekenhuisvoorzieningen (2015) Advies betreffende de alternatieve zorgvormen

Huntley AL, Chalder M, Shaw ARG, Hollingworth W, Metcalfe C, Benger JR, Purdy S (2017) A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission. BMJ Open 7:e016236

Philp I, Mills KA, Thanvi B, Ghosh K, Long JF (2013) Reducing hospital bed use by frail older people: results from a systematic review of the literature. Int J Integr Care 13:e048

Pedersen LH, Brynningsen P, Foss CH, Gregersen M, Barat I, Damsgaard EM (2018) Avoidable readmissions seem to be reduced by early follow-up visits for geriatric patients discharged from hospital. Eur Geriatr Med 9:613–621

Sermeus W, Delesie L, Van den Heede K, Diya L, Lesaffre E (2008) Measuring the intensity of nursing care: making use of the Belgian Nursing Minimum Data Set. Int J Nurs Stud 45:1011–1021

Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, Diomidous M, Kinnunen J, Kozka M, Lesaffre E, McHugh MD, Moreno-Casbas MT, Rafferty AM, Schwendimann R, Scott PA, Tishelman C, van Achterberg T, Sermeus W, Consortium RC (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 383:1824–1830

Leary A, Punshon G (2019) Determining acute nurse staffing: a hermeneutic review of an evolving science. BMJ Open 9:e025654

Leroy R, Camberlin C, Lefevre M, Van den Heede K, Van de Voorde C, Beguin C (2017) Variability in elective day-surgery rates between Belgian hospitals—analyses of administrative data explained by surgical experts. Int J Surg 45:118–124

Lewis R, Edwards N (2015) Improving length of stay: what can hospitals do? Nuffieldtrust

Golden AG, Silverman MA, Issenberg SB (2015) Addressing the shortage of geriatricians: what medical educators can learn from the nurse practitioner training model. Acad Med 90:1236–1240

Kovner CT, Mezey M, Harrington C (2002) Who cares for older adults? Workforce implications of an aging society. Health Aff (Millwood) 21:78–89

Barriball L, Bremner J, Buchan J, Craveiro I, Dieleman M, Dix O, Dussault G, Jansen C, Kroezen M, Rafferty AM, Sermeus W (2015) Recruitment and retention of the health workforce in Europe. In: Workforce D-GfHaFSRaRotH (ed) Brussels

Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49–e55

Van Grootven B, Flamaing J, Dierckx de Casterle B, Dubois C, Fagard K, Herregods MC, Hornikx M, Laenen A, Meuris B, Rex S, Tournoy J, Milisen K, Deschodt M (2017) Effectiveness of in-hospital geriatric co-management: a systematic review and meta-analysis. Age Ageing 46:903–910

Buecking B, Timmesfeld N, Riem S, Bliemel C, Hartwig E, Friess T, Liener U, Ruchholtz S, Eschbach D (2013) Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis. Dtsch Arztebl Int 110:255–262

Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, Valecchi R, Rinonapoli G, Caraffa A, Mecocci P, Ruggiero C (2019) The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 30:907–916

Wright J, Williams R, Wilkinson JR (1998) Development and importance of health needs assessment. BMJ 316:1310–1313

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