Quantitative Evaluation of Age Disparities in the Quality of Geriatric Acute Medical Care in Japan

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Abstract
Background: In the era of an aging population, stakeholders should recognize the presence of age disparities for the delivery of acute care. Few studies have assessed the association between resource use as an input and functional recovery as a health outcome among older people. We examined the disparity in care quality for patients aged ≥ 60 years with stroke, hip arthropathy or bone injury. Methods: Using a Japanese administrative database with 5 years of data starting in 2004, we identified 35,566 patients with stroke, 2537 with hip arthropathy, and 7427 with hip bone injury across 151 acute care hospitals. Demographic characteristics, functional status at admission and discharge, length of stay (LOS), and total charges (TC) were analyzed for specific age categories (60–69, 70–79 and ≥ 80 years). Independent effects of age on these parameters were determined. Results: Overall, 10,239 (29%) patients with stroke, 321 (13%) with arthropathy, and 747 (36%) with bone injury were aged ≥ 80 years old. The proportions of surgical procedures for patients aged ≥ 70 years with stroke, arthropathy and bone injury were 20%, 91% and 90%, respectively. The 70–79-year-old group was associated with greater LOS or TC for each disease, except for LOS in arthropathy. The degree of functional recovery decreased with increasing age, except hip arthropathy. Conclusion: Disparities in resource use and functional recovery were observed by disease and age. To maintain social activity among older people, stakeholders should acknowledge the variations in care quality and establish priorities for quality improvement initiatives in hip arthropathy.

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