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In the past quarter-century, the average age and the age distribution of hospital patients in the United States have changed dramatically. In 1970, the average age of U.S. inpatients was 40.7 years, and 20% of all inpatients were aged 65 years or older. By 2002, the average inpatient age had risen to 52.1 years, and 38% of all inpatients were 65 or older. Moreover, data about the lengths of hospital stay show that the 38% of inpatients who were elderly stayed in the hospital longer, on average using in the aggregate 45% of the total days of care.i The rates of surgery by age group also reveal the dominance of the elderly surgical patient: in American hospitals for the twelve most common surgical procedures performed for each age group, elderly patients averaged 747 procedures per 100,000, a rate that is more than double that for patients aged 45 to 64 (338) and more than three times that for patients aged 15 to 44 (204). In summary, elderly patients constitute an ever-growing sector of all hospitalized patients, they use more days of care than younger inpatients, and they are far more likely than younger inpatients to undergo surgery. One reason for their longer lengths of hospital stay is that elderly patients experience more potentially preventable perioperative problems and complications than younger patients. These common complications include acute renal failure, adverse drug events (incidence 10% to 15%), functional decline due to deconditioning and immobility (incidence 32%), dehydration (prevalence 7%), delirium (10% to 50% in postoperative patients), depression, falls (incidence 4 to 11 per 1000 patient days), urinary incontinence (prevalence 11% on admission and 23% on discharge), infection (especially lung, intestinal and urinary tract infections), protein-calorie malnutrition (prevalence as high as 61%), pressure ulcers (incidence 3%), and untreated or under treated pain syndromes. To further dramatize these facts, by 2030, the proportion of the U.S. population that is aged 65 or older is expected to increase from 12.4% in 2000 to 19.6%, or about 1 in 5 Americans. The number of elderly Americans is expected to double during this 30-year period, from approximately 35 million to 71 million. The number of oldest-old Americans, those aged 80 years or older (the age group of patients in the United States with the highest hospitalization rate), will increase from 9.3 million in 2000 to 19.5 million in 2030. If life expectancy continues to increase at the same rate seen in the 1990s, the number of oldest-old people could balloon to 31.2 million by 2050. It is widely accepted that the old old population on average requires three hospitalizations for medical and surgical conditions every year making this group the heaviest users by far of inpatient beds. In recognition of this demographic shift, many Certification Boards and Residency Review Committees have added requirements that demonstrate a physician's knowledge of caring for older patients. It is probable that, ultimately, all Boards and RRCs, with the exception of pediatrics, will add similar requirements. Whether or not your specialty Board or RRC has such requirements, chances are your residents will have a large number of older patients under their care. To help best prepare them for the future, we encourage you to participate in the Geriatrics Education for Specialty Residents (GSR) program. The GSR is offered by the American Geriatrics Society (AGS) through the John A. Hartford Foundation funded Geriatrics-for-Specialists Initiative (GSI), a comprehensive initiative designed to improve the health care of older patients by enhancing specialists' knowledge of geriatrics.
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