Older patients demand fewer resources
Do the oldest dying patients expect less than those from younger generations?
Two researchers have investigated how much help some 36,000 Norwegians received from the health services in the last three years of their lives.
The figures show that persons aged around 60 had an average of 5.2 hospitalizations in their last years of life.
Persons around 90 years old, by comparison, had just 2.8 hospital admittances on average in their final years.
There can be many reasons for this difference. One could be age discrimination, in other words, ageism. Or today’s middle-aged Norwegians might expect more in general than the generation before them.
Jon Ivar Elstad, researcher at OsloMet, has with the assistance of the retired Chief Physician Ola Reiertsen looked into how much Norwegians use hospitals in the last phase of their lives. Over 36,000 persons and over 135,000 hospital admittances comprised the data for the study. The result has been presented in the medical journal Tidsskriftet which is published by the Norwegian Medical Association.
Big differences in use of resources
Expected life spans have increased and old people become an increasingly larger segment of the population. This naturally raises the demand for health services.
However, these new figures show that the oldest persons who are dying use the health services less than younger patients who are terminally ill.
An earlier study pointed in the same direction. It showed that a dying 85-year-old on average only demands half the hospital resources of a 65-year-old in the same situation.
It is feasible that longer life spans can lead to less use of hospital services in the terminal phase of life.
But this is far from certain. Especially if coming generations of 80- and 90-year-olds will be demanding more from the health services and hospitals.
Should the oldest be given less help?
In another article in the same issue of the Norwegian medical journal Tidsskriftet, Ivar Sønbø Kristiansen and Christoffer Bugge comment on the findings of Elstad and Reiertsen.
They question whether this isn’t what can be expected – that it is natural and fair for hospital usage in the last phase of life to be lower amongst elder groups of patients.
Kristiansen and Bugge think ageism can be playing in as a factor here. But they do not consider it to be the main issue.
An alternative explanation could be that many of the eldest terminal patients get their treatment at nursing homes. Unfortunately, there is a lack of good data to confirm this, or rule it out. But it is known that Norway’s municipalities spend about 100 billion NOK, or $12.3 billion, per year on nursing home services. That is in a country with a population of 5.3 million.
New generation of pampered elderly?
Another alternative could be that today’s oldest Norwegians belong to generation which demands less and expects less of health services than do their children born who grew up in post-war Norway and grandchildren who grew up in a Norway with oil money.
Figures from the Tromsø study point in that direction. It shows that the use of hospital polyclinics is higher among the age group 40–49 than among those aged 70 and up, even though health problems and mortality rates are naturally higher in the latter group.
Kristiansen and Bugge are concerned that in the future Norwegians can experience a large increase in the demand for health services when today’s middle-aged persons reach an age with disease and high mortality.
Over-treatment of cancer patients?
The two also question whether cancer patients who are nearing death might be getting more treatment, thus at a greater expense, than is necessary.
However, they point out that such treatment in the final year or years of life is greatly appreciated by patients and their families.
In any case, Kristiansen and Bugge think Norwegians need to be prepared for higher public healthcare costs in the years to come. Costs could rocket as medical breakthroughs enable the health care services to treat more patients with new methods, ones that often don’t come cheap.
The politicians who have national and local budgets to pass and maintain might respond to such rises in costs by demanding more efficiency from hospitals and other sectors of the health services.
Jon Ivar Elstad and Ola Reiertsen: “Sykehusinnleggelser de tre siste leveårene”, Tidsskriftet, 28 May 2018
Ivar Sønbø Kristiansen and Christoffer Bugge: “Prioritering i pasienters siste leveår”, Tidsskriftet, 28 May 2018
Translated by: Glenn Ostling