Abuse of the aged

Families of the deceased are beginning to wonder if anyone is alarmed besides themselves at the disproportionately higher levels of adverse events  [1] consistently associated with the elderly.

Their acute observations are worth noting considering the sources listed in the footnotes provide the data which most families would be unaware of.

While in general part of this occurrence may be readily associated with the presence of co-morbidities raising the degree of complexity of care required;  less of an ability to withstand and recover from the stress of invasive procedure; also to some degree a lack of pharmacological trials with older participants;  together with a higher degree of sensitivity to some medications may also be relevant here.

The frequency of permanent disability or death resulting from an adverse event increased with increasing age … [ 2 ]

In short the aged are more susceptible to a wide host of factors, notwithstanding these, it should also be noted that:

  • Older age patients may expect to wait for required procedures for longer periods than younger patients waiting for similar procedures – this discrimination is apparently consistent with current triage principles.
  • Older patients in general do have longer lengths of stay in hospital. [3]
  • Older patients who have suffered an adverse event compared to younger age groups will also spend longer in hospitals. [4]
  • Older age patients in public teaching hospitals are more inclined to be cared for and treated by inexperienced junior clinicians.
  • In one study adverse event rates associated with “major organ system disease” were highest in public teaching hospitals as compared to other public and private institutions. [5]
  • The decrease in length of stay and bed numbers has resulted in increased complexity and severity of illness for inpatients. [6]
  • Data collection is dubious in quality – older patients are readmitted more often – this fact is obscured by the reporting of all age figures for readmission. [7]
  • With the increase of college graduates, the decrease of senior nurses, the increase in patient throughput and not enough time for more supervision, incidents occur. [8] 


Observations from ABC Four Corners “E.R. Emergency Roulette”, telecast 16/10/1995, displays little has changed in the 15 years since:

  • Elderly often cost more and take longer to treat.
  • Efficiency is based on minimum handling and standardized treatment.
  • No loading for compassion… no bonus for happy customers.
  • The buzzword is “throughput”.
  • With the elderly, hospitals struggle to ensure their costs for treating a patient will be covered by the price the government pays.
  • Patients with chronic problems or multiple conditions become very unprofitable… often they are the elderly.
  • The aged are probably suffering the most under the disastrous Casemix system.
  • Elderly are not profitable to manage in hospital.
  • Elderly take a bit longer to fix… insultingly known as “bed blockers”.
  • Heart attacks, e.g. allowed 7 days in hospital.
  • Hospitals are paid set prices based on average cases.
  • If you’re not average and elderly, it’s hard to get in, and once you do, you’re quickly out the door.
  • While many elderly patients are having trouble getting into public hospitals, some GPs no longer even bother trying to get their elderly patients admitted.

Given that the risk factors in general may be higher – for the older patient and may require experienced care more urgently – the risk factors for the junior clinician and the hospital as a financial entity are monetarily negligible given the status of the elderly according to the law.  The rationale behind this paradox of care needs addressing; the current situation is ethically abhorrent.

The elderly have paved the way for this generation to benefit.  Society has an obligation and government a duty to see that the elderly are cared for in their senior years.  If we fail to care for them in life, then we have a moral duty to not fail them in death by seeing that something, no matter how small, has been learnt from their adverse event death.  They are owed more than just being another medical statistic.  We are next!

The National Coroners Information System [NCIS] is a valuable tool in identifying these trends.

[1]  Reporting of Adverse Events in Hospitals in Victoria, 1994-1995, page 461, table ‘Age group chart’.
[2]  The Final Report of the Taskforce on Quality in Australian Health Care, page A18, 3rd bullet point from top.
[3]  National Hospital Morbidity Database 1997-98.
[4]  National Hospital Morbidity Database 1997-98.
[5]  Reporting of Adverse Events in Hospitals in Victoria, 1994-1995, page 463, Table 4.
[6]  [7]  [8] Victoria Acute Health Services Under Casemix – A Case of Mixed Priorities, page 105, ‘Quality of Care: Adverse Events’.

17.08.04 The Bulletin Broken Trust    Epidemic of errors kills aged 028     Elderly men most at risk in hospital errors       


15.02.11 NHS has failed the elderly, says damning report     15.02.11 NHS treatment of the elderly condemned