Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system. Few of the currently favoured proposals promote age-inclusivity and older people's rights to equal access to acute care.