Hospital utilisation in Australia, 1993–2020, with a focus on use by people over 75 years of age: a review of AIHW data

To the Editor: I read with great interest the excellent article by Reid and colleagues1 on national hospital utilisation trends between 1991 and 2020 and the accompanying editorial by Visvanathan and Campbell.2 The focus of these two articles was to highlight trends in older people, aged over 75 years. Their data showing declining hospital utilisation and increasing admission rates for such people lead them to suggest that attempting to reduce length of stay and limiting bed availability for older people may not be viable for the future, akin to “flogging a dead horse”. However, both articles seem to have skimmed over an interesting finding, namely the magnitude of decline on length of stay in different age categories. Reid and colleagues showed in Box 8 of their article that the mean length of stay for multiple day hospital admissions declined from 6.6 days in 1993–94 to 5.4 days in 2019–20 (18% reduction). However, for patients below 65 years of age it declined very little over the same period, from 4.9 to 4.6 days (7% reduction), compared with substantial declines from 8.4 to 5.8 days (31% reduction) for people aged 65–74 years, 12.2 to 7.1 days (42% reduction) for patients aged 75 years or more, and 15.2 to 7.7 days (49% reduction) for patients aged 85 years or more.

To my mind, this likely reflects a vast amount of attention being cast towards discharging older people earlier to free up hospital beds, while not affording the same effort towards discharging younger people earlier. Younger age, at least for some diagnostic categories, is likely to be associated with good outcomes in out‐of‐hospital care. Is it time to acknowledge that the older community have “done their bit” towards freeing up hospital beds, and that we need to call time on the prevalent ageism in hospitals, and instead create opportunity by looking closely at why length of stay has not declined in younger people?