Significant Rise in Number of Young Adults in Children's Hospitals
A 10-year study at the Royal Children's Hospital (RCH), Melbourne, has shown a significant rise in the number of young adults (aged 18 and over) being admitted to the RCH, according to research published in the latest issue of the Medical Journal of Australia. Increasing disease complexity and inadequate planning for transition from child- to adult-orientated health services have contributed to the increase.
The authors, Pei-Yoong Lam, Bronwyn Fitzgerald and Susan Sawyer of the RCH Centre for Adolescent Health, say that barriers to timely transfer mean some young people continue to use paediatric services until well into their 20s.
The RCH audit showed a significant rise in the number of young adults admitted over the 1992-2001 survey period, from 308 in 1992-1993 to 659 in 2000-2001, the greatest increase being in admissions to surgical units.
Many young adults needed multidisciplinary care, with 57 per cent having more than three medical/surgical units involved in their care, and 34 per cent having two or more allied health units involved.
Fifty-one per cent of surgical inpatients and 28 per cent of medical inpatients had no documented plan for transition to adult care. Only 30 per cent of medical and 17 per cent of surgical inpatients in 2001 had been transferred to adult services by 2002.
A key element in the upward age shift in hospital paediatric practice across the Western world is the increased prevalence of chronic illness in childhood and adolescence, say the authors.
Children with previously fatal early-childhood conditions, such as extreme prematurity, congenital cardiac disease and cystic fibrosis, now frequently survive through adolescence because of improved clinical care.
There also has been a true increase in chronic illnesses such as asthma, diabetes and acute lymphoblastic leukaemia. In addition, young people are now more likely to be obese, have mental disorders or suffer from HIV.
The authors recommend greater support for transition planning. But they are also concerned about the lack of appropriate services within the adult health care sector for young people who have complex, multidisciplinary health care needs.
In an editorial in the same issue, David Bennett and Susan Towns, of the Children's Hospital at Westmead, and Kate Steinbeck, of the Royal Prince Alfred Hospital, say Australia urgently needs to develop a national policy on transitional care. It would need to have a strong focus on such areas as educating health professionals and families, developing appropriate attitudes and expertise in adult services, and involving consumer advisory groups. They propose a model for constructing a transition plan.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Associate Professor David BENNETT 0419 460 513
Professor Susan SAWYER 0408 181 260 / 03 9345 6597
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471