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Older Women Now Surpass Young Men in Admissions; Population Shifts Cited

By Julie Ishida

The Washington Post, September 15, 2003

Reversing a decades-old pattern, older women have replaced young men as the group most likely to wind up in a hospital bed after accidental injury, according to a recent study.

The shift reflects the growth in the number of frail elderly people and changes in emergency room treatment that have sharply reduced the need to hospitalize younger patients, said the researchers from the Harvard Injury Control Research Center, who published their findings last week in the journal Injury Prevention.

The trend is likely to put new burdens on the health care system, and underscores the need for more efforts to prevent injury and the resulting costly hospitalizations among older Americans, particularly women, they said.

"It makes prevention all the more important because it is so much more costly to take care of older people who are injured," senior author David E. Clark said.

Falls account for most injuries in older women, but motor vehicle collisions are responsible for a significant portion. Older women, who are at risk for the bone-thinning disease osteoporosis, are especially prone to hip injuries.

Once elderly patients arrive at the hospital, doctors must be attuned to the need to minimize complications and restore or maintain physical functions that can deteriorate rapidly in elderly patients, said Clark, also a trauma surgeon at Maine Medical Center in Portland.

"We can't assume that our older patients will bounce back after their injury is treated, because they are weaker, more likely to have underlying medical problems and to have complications," he said. "The medical and social situations are much more complicated than the ones we had to deal with before when most of the patients were young and relatively healthy."

The analysis was based on data collected by the U.S. Centers for Disease Control and Prevention from 1979 to 2000, through the annual National Hospital Discharge Survey, a random sampling from hospitals nationwide.

From 1996 to 2000, women 65 and older accounted for 28 percent of hospital admissions after injury, overtaking men younger than 40, who accounted for 26 percent. From 1979 to 1983, young men represented 41 percent of hospital admissions after injury, while elderly women accounted for 14.5 percent.

The aging of the population is only a small factor in the trend, the researchers said. Rates of hospitalization after injury have decreased in most age groups over the past two decades but fell most dramatically for young men.

That change may result from a lower rate of injury among young men and better emergency treatment methods that avoid hospitalization for younger adults' injuries, Clark said. Older patients may be more likely to be admitted because of concerns about other medical conditions and safety upon discharge.

The study also found that older people are increasingly likely to be discharged to rehabilitation centers and nursing homes rather than to their homes. Younger patients were typically discharged from hospital to home.


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