For several years health systems have been adding
programs that tailor services and care experiences for
the rapidly growing population aged 65+. While it is no
surprise that utilization trends for the 18 to 64 age cohort
look different than those for the 65+ population, a closer
look at utilization patterns reveals notable differences
even within the 65+ age cohort. This underscores the
importance of assessing patterns for distinct 65+ age
groups, specifically 65 to 74, 75 to 84 and 85+. Only then
can health system leaders proactively design care delivery
models, workforce strategies and capital investments that
are attuned to the specific needs of each segment. But
first, as Figure 1 illustrates, a holistic look at patterns for
the 65+ population across hospital cohorts and sites of
care shows consistently high utilization as compared to
the 18 to 64 demographic.
Segmenting the 65+ patient population among different dimensions
Figure 1. Impact of 65+ age cohort on healthcare utilization
Note: Analysis excludes 0-17 age group. 0% indicates the forecast is
flat (less than ±1%). CAMC = comprehensive academic medical center; CCMC = complex care
medical center; CMC = community medical center; ED = emergency department; IP =
inpatient; LSMC = large specialty medical center; OP = outpatient. Sources:
Data from Vizient® Clinical Data Base used with permission of Vizient, Inc. All rights
reserved. Accessed April 2025. Impact of Change®, 2024; HCUP National
Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2019. Agency for
Healthcare Research and Quality, Rockville, MD; Proprietary Vizient AllPayer Claims Data
Set, 2022; The following 2022 CMS Limited Data Sets (LDS): Carrier, Denominator, Home
Health Agency, Hospice, Outpatient, Skilled Nursing
Facility; Claritas Pop-Facts®, 2024; Vizient Insurance Coverage Estimates, 2025; Claritas
Demographics, 2025; Vizient Strategy Analytics, 2025.
- Although the 65+ population represents a significant
proportion of the patient base for comprehensive
academic medical centers (AMCs), they represent a
larger proportion of community hospital–based care,
indicating a need for lower-acuity inpatient services.
- An increase in utilization across all sites of care will
be driven by the 65+ population, as utilization among
younger adults is projected to remain flat or even
decline in some settings over the next 10 years.
- Looking at insurance enrollment trends, Medicare
Advantage enrollment is projected to grow by 33%
the next five years, while traditional Medicare is
expected to decline by 8%. This will place additional
pressure on capacity, given current challenges
with prior authorization requirements for Medicare
Advantage plans.
A closer look at emergency department utilization trends across hospital cohorts
Compared to academic medical centers, community
hospitals see a higher share of older adults presenting to
the emergency department, resulting in a greater volume
of higher-acuity patients (see Figure 2). In 2024, 72% of
ED visits for adults aged 65+ were classified as emergent,
higher than the 65% rate for adults aged 18 to 64. This
share is projected to increase further.
Figure 2: % of ED visits by 65+ population, 2024
Note: Analysis includes 65 and over age group only; community hospitals
include CCMC and CMC. Source: Data from Vizient Clinical Data Base used with permission
of Vizient, Inc. All rights reserved. Accessed April 2025.
Over the next decade, ED emergent visit volume for
the 65+ population is expected to grow by 28%, with
the 75 to 84 age cohort alone projected to see a 45%
increase—double the increase of each of the other two
65+ age cohorts. Given this trajectory, health systems
must identify strategies to reduce patients’ reliance
on the ED and acute care services by expanding access
to primary and specialty care services and leveraging
technology to better manage chronic conditions, thus
improving care quality, hospital efficiency and capacity.
Select quality benchmarks for inpatient care
Figure 3. Inpatient quality metrics
Note: Analysis excludes 0-17 age group; Q1 2024-Q4 2024. ALOS = average
length of stay. Sources: Data from Vizient Clinical Data Base used with permission
of Vizient, Inc. All rights reserved. Accessed April 2025.
- Overall, more than 77% of IP admissions for older
adults originate from the ED, with non-academic
hospitals having higher proportions than AMCs.
- While AMCs typically report higher average length of
stay due to their greater share of clinically complex
cases, it is notable that the 65 to 74 and 75 to 84 age
cohorts have a longer length of stay at AMCs than the
oldest cohort, as shown in Figure 3.
- As Figure 3 indicates, patients aged 65+ have higher
complication rates at AMCs compared to non-AMCs,
though complication rates decrease with increasing
age cohort.
- The 30-day readmission rate remains elevated across
all 65+ age cohorts (from 11.2% to 12.4%) compared
to the all-ages average (10.5%). While opportunities
to significantly reduce these rates may be limited,
health systems can better manage the impact
through more robust capacity planning and enhanced
transitional care models.
- Inpatient days are projected to increase by 17% over
the next decade, according to the Vizient Impact of
Change® forecast. Notably, the 75 to 84 age group is
expected to see a 40% increase, more than double the
overall rate, reinforcing the need for focused planning
and resource alignment for this high-growth cohort.
Assessing transitions to post-acute care
Figure 4. PAC utilization by 65+ age groups
Note: Analysis includes 65 and over age group only. LTC = long-term
care; PAC = post-acute care; SNF = skilled nursing facility. Sources: Data from Vizient
Clinical Data Base used with permission of Vizient, Inc. All rights reserved. Accessed
April 2025. Impact of Change®, 2024; HCUP National Inpatient Sample (NIS).
Healthcare Cost and Utilization Project (HCUP) 2019. Agency for Healthcare Research and
Quality, Rockville, MD; Proprietary Vizient All-Payer Claims Data Set,
2022; The following 2022 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health
Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas
Pop-Facts®, 2024; Vizient Strategy Analytics, 2025.
As expected, the 85+ age cohort has the highest proportion of discharges to post-acute care
settings—more than
double that of the 65 to 74 age cohort (see Figure 4). However, all 65+ age groups are projected to
see an increased
volume of discharges to some form of post-acute care, such as a skilled nursing facility, long-term
care, home health
or hospice, over the next decade. Once again, the 75 to 84 age group stands out, with projected
growth nearly double
that of the younger and older 65+ age cohorts.
