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Increasing importance of the elderly in a trauma system*,**

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Abstract

The objectives of the study were to determine age- and sex-related trends in hospitalization after injuries. Statewide hospitalization data from 1980-1999 were evaluated annually by sex and age (0-39, 40-64, 65-99), incidence, mean length of stay (LOS), and disposition. Males 0-39 represented 39.6% of admissions in 1980, but only 20.7% in 1999; females ≥65 are now most frequent. These trends partly reflect population changes, but rates of hospitalization for young men have also declined. For age < 65, LOS has gradually decreased since 1980; for age ≥ 65, LOS decreased after 1990. However, most elderly patients were formerly discharged home, whereas now most are discharged to skilled nursing facilities (SNF). The proportion of younger patients hospitalized in trauma centers increased significantly, but over age 65 this proportion remained stable. Major changes have occurred in populations served by trauma systems. Preventing injuries in the elderly is increasingly important. Accurate evaluation of cost-effectiveness in the elderly must include outcomes from SNF. (Am J Emerg Med 2002;20:108-111. Copyright 2002, Elsevier Science (USA). All rights reserved.)

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Methods

For the years 1980-1999, hospitalization data were requested from the Maine Health Data Organization (MHDO) under the rules and confidentiality restrictions permitted by Maine law for public health research. These data included inpatient discharge abstract information for all cases whose principal International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code indicated an acute injury (800-904.9, 910-929.9, 940-959.9).

For each case, an approximate Injury

Results

The most striking change over the past 2 decades has been the absolute decrease in the number of males aged less than 40 years admitted to a Maine hospital after injury, from 5,090 in 1980 down to 1,462 in 1999 (Fig 1).

. Annual numbers of patients hospitalized after injury in Maine, 1980-1999, grouped by age and sex. Male groups shown with solid lines and female groups shown with dashed lines.

Young males accounted for 39.6% of hospital admissions after injury in 1980, but only 20.7% in 1999 Women

Discussion

Emergency physicians and surgeons in practice over the past 2 decades have certainly noticed the steady increase in the number of elderly patients, documented by these data from one U.S. state. This trend is likely to increase even faster as the “baby boom” generation enters old age during the next few decades. The U.S. population over age 65 is projected to double between 2000 and 2030, and if rates of injury requiring hospitalization remain constant, the number of elderly trauma patients will

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*

Address reprint requests to David E. Clark, MD, 887 Congress Street, Portland, ME 04102. E-mail: [email protected]

**

0735-6757/02/2002-0011$35.00/0

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Copyright © 2002 Elsevier Science (USA). Published by Elsevier Inc. All rights reserved.