Hospital use and outcomes in somatic patients aged 80 years and older: a retrospective register study from a Norwegian tertiary hospital, 2002-2022.

AIM To document admissions, outcomes, and survival in somatic hospital patients aged 80 years and older over two decades.

METHODS We performed a retrospective study of patients aged 80 years and older admitted to a university hospital in Bergen, Norway, in 2002, 2012, and 2022. Patient factors such as age, sex, and complex multimorbidity were considered important for 12-month survival and were used as predictors in a Cox regression model.

RESULTS Annual admissions increased by 74%, from 5589 to 10,273, over the two decades, while the proportion of unplanned admissions (77%) remained constant. Median hospital length of stay decreased from 5 to 3 days, with a moderate increase in the 30-day readmission rate from 14.6% to 17.3%. In-hospital mortality declined from 10% to 4.7%, and one-year mortality declined from 25.1% in 2012 to 23.1% in 2022. The risk of death was higher with increasing age (hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.21-1.26), readmission (HR 2.25, 95% CI 1.56-3.23), complex multimorbidity (HR 1.24, 95% CI 1.85-3.56) and male sex; women had a 26% lower risk of dying compared with men (HR 0.74, 95% CI 0.66-0.82). All predictors were significantly associated with all-cause mortality (Cox proportional hazards model with interaction terms, P<0.001).

CONCLUSIONS

The increase in admissions reflects demographic changes over the past decades. If this population continues to grow towards 2050 as expected, the healthcare system will face major challenges in meeting the demand. Alternatives to hospital admission for older patients should be developed, alongside clearer prioritisation of admission criteria.