[Acute hospital care for the elderly in Italy: comparison between 2001 and 2006]

The continous health expenditure increase in developed countries is often related with the acute hospital care of the elderly. To monitor the characteristics of elderly acute hospital care included the expenditure trend is crucial in order to identify the appropriateness of this care. The aim of this study is to describe quality and quantity of in-hospital care use of elderly population in Italy in 2006 and to compare the results with the same information gathered for 1996 and 2001. All the 2006 acute hospital admission longer than one day of the patients older than 64 years sourced from the Register of Discharge Form of the Italian Ministry of Health have been analyzed. A list of the 30 more frequent diagnoses has been compiled and compared with the same list compiled for 2001. On the basis of the National Fee for each Disease Related Group an analysis of the hospital expenditure has been carried out. The correlation between DRGs National Fees and frequency of the diagnosis in the discharge form has been based on the 80 diagnosis that has been recorded for more than 10.000 discharge forms in 2006. A relevant increase of acute hospital admission for respiratory, cardiovascular and urinary pathologies among the elderly has been observed. Moreover the number of hospital admissions for major joints and implant of lower limbs is doubled from 1996. The total health expenditure for the elderly acute care longer than one day is increased of 6.3% and a positive correlation between higher DRGs fees and higher frequency of diagnosis has been observed (Pearson correlation value = 0.478; p<0.001 - cubic regression R-square value = 0.301; p<0.001). The hospital acute care use of the elderly patients seems to be more related to emergency care than in the past, while a decrease of DRGs related to chronic diseases and generic diagnosis has been observed. The more frequent cause of in-hospital admission seems to be related also to a higher DRGs fee. As already observed in the past years, a trend towards the use of more expensive DRGs could be detected.