Trends in the use of hospital beds by older people in Australia: 1993–2002

To the Editor: Gray, Yeo and Duckett used the wrong basis of measure for their analysis of bed trends.1 Bed use per thousand of the population masks the trends in total bed-days or separations and does not address the issue of supply. These issues have important ramifications for policy decision-making.

Using the same sources of data,2,3 we compared bed-related statistics and population changes for the periods 1993–94 and 2001–02. What should be of most interest to planners is that the number of multi-day bed-days only declined marginally (from 14 434 to 14 231; −1.4%), despite the significant increase (from 1698 to 3343; + 96.8%) in same-day activity.

Although multi-day separations and bed-days did decline (separations, − 4.2%; bed-days, − 14.9%) for those aged 65–74 years, for those aged 75 years or over bed-days and separations increased significantly (separations, + 41.6%; bed-days, +27.7%). Furthermore, same-day activity increased significantly for those aged 65 or more years.

Furthermore, the authors failed to highlight the implications of changes in the relative age mix of activity. For those aged 75 years or more, the increase in proportion of separations (+ 5.8 percentage points) and bed-days (+ 1.8 percentage points) was greater than the increase in this proportion of the population (+ 1.1 percentage points). For the 65–74-years age group, the proportion of same-day hospital activity increased (+ 1.3 percentage points), unlike the reduction in that proportion of the population (− 0.2 percentage points).

Moreover, the question of whether an ageing population has resulted in the need for more beds can not be answered without considering the supply of beds. From our experience, the growth in same-day activity has been achieved, at least in part, by substituting same-day beds for inpatient beds. The need for increased same-day beds has been considerable. Statistics relating to same-day beds do not appear to be reported for Australia as a whole. However, the increasing implied bed occupancy (including same-day) shown in the Box supports this conclusion.

We surmise that the reduction in supply of multi-day beds combined with a marginally altered demand for multi-day beds has led to increasing numbers of bed crises. Given that relative growth in same-day activity can be attributed to people aged 65 years or over, and that the number of multi-day bed-days for those aged 75 years or more has increased, it appears that the ageing of the population, combined with the manner in which the substitution of beds has occurred, has contributed to increasing bed crises.