‘Silver tsunami’ triggers hospital trauma

“All those patients that didn’t die of their heart attacks and strokes from 20 years ago, due to the increase in successful therapies that we now use, come back with dementia and multiple illnesses later.” 

This provocative observation by leading Australian emergency specialist Dr David Green highlights the mounting pressure on our already strained hospitals to cope with the number of frail older people coming through their doors and filling up beds.  

Hospital managers are concerned they are barely keeping pace with older patients needing extended treatment and stays because of falls and associated conditions. 

In 2020-21, more than 140,000 65-plus Australians were hospitalised because of falls. Of those, 5,500 died. 

The pressure is expected to grow as Australia's population ages, in what is referred to as the “silver tsunami”. 

“We decided we had to do something about it because this is going to be the trend in the next few years to come – many years to come,” Sydney’s Alfred Hospital’s trauma department deputy director, Associate Professor Joseph Mathew, said. 

Dr Mathew says it’s too common to hear of an older person who has had a fall and “has not been fully diagnosed and has then turned a critical downturn after that, and they just worsen and end up dying”. 

He says The Alfred is only seeing the tip of the iceberg for geriatric trauma. 

“There is a much larger cohort that is presenting to suburban hospitals and regional hospitals, and there's quite a lot of significant evidence to suggest that they are under-triaged, and the severity of the injuries are under-recognised.” 

The Alfred recently developed a specialised Geriatric Trauma Service to cope with a 20% increase, in one year, in falls from standing height. 

The hospital decided that older people should be considered as a specialist group, requiring special care. 

The Alfred model recognises the need to bring together the traditional trauma service and the geriatric medicine team. It’s a synergy that enables staff to think about the big picture: not just about the injuries, but about the person. 

Geriatric specialists want the government to recognise and fund geriatric care, especially geriatric trauma care. 

“This is not exactly a fashionable area of trauma and people talk less about it, but it is turning out to be a bulk of the trauma we're dealing with,” a doctor told the ABC. 

The Australian Medical Association (AMA) is backing those calls and says British and American models provide a guide. 

The AMA’s Cilla Haywood said it’s a matter of “getting the money and the training” and warns it will take years to get people trained to the right standard. 

“We probably should be getting onto it now and funding it more now, so that we have a more solvent and more sustainable health care system.” 

Are geriatric trauma centres enough? 

The head of one of the busiest emergency departments (ED) in Australia, Gold Coast University Hospital’s David Green, said the solution lies in building new geriatric hospitals. 

He said admitting patients to a ward from the ED in an appropriate timeframe was hospital staff’s “biggest challenge”. 

He told ABC News the problem was an increase in the number of elderly patients occupying hospital beds. 

“All those patients that didn’t die of their heart attacks and strokes from 20 years ago, due to the increase in successful therapies that we now use, come back with dementia and multiple illnesses later,” Dr Green said. 

The bed shortage causes a ripple effect including ambulance “ramping” (the backlog of ambulances parked outside a hospital). 

Dr Green wants dedicated hospitals, similar to children’s hospitals, that offer specialised care for people over 65 could ease that backlog by offering services that acknowledge the complexities involved in geriatric care. 

However, Griffith University Health educator, Jennifer Kosiol, isn’t convinced. 

She said the main issue is the time patients remained in hospital awaiting transfer to an aged care facility. 

“If we don’t have people that have a next of kin [or] an enduring power of attorney and they’re not cognitively able to make decisions for themselves, we then have to rely on getting them a guardian through QCAT (Queensland Civil and Administrative Tribunal) and that process can take six months,” Dr Kosiol said. 

Meanwhile, Bond University academic, Kieran Le Plastrier, is urging policymakers to stop putting older people at risk from fragmented care. He wants greater investment in holistic, preventative care. 

“We’ve got a great sick care system, but we don’t have a fundamentally efficient healthcare system where we keep people healthy,” he said. 

“If you focus on people being able to get timely access to preventative care before they get really unwell, you can actually prevent hospitalisations. So, that's got to be a key part of how we reframe healthcare in Australia.” 

Related reading: ABC 1, Alfred Health, ABC 2