Why are older Australians waiting so long in emergency departments?

The ACEM State of Emergency report points to a combination of factors: rising aged care demand, insufficient inpatient bed capacity, and a health system that was not designed for the volume and complexity of presentations from an ageing population. Nearly one in five Australians will be 65 or older by 2030.

What can a GP do about ED overcrowding?

Consistent, proactive management of chronic conditions in older patients — including annual health assessments, medication reviews, advance care planning, and GP-initiated aged care access — reduces the avoidable ED presentations that drive this pressure. The RACGP 75+ health assessment (MBS item 703) is one practical entry point.

EDs overwhelmed by ageing Australians: ACEM's 2026 State of Emergency

The Australasian College for Emergency Medicine (ACEM) has released its third annual State of Emergency report, and the numbers are specific enough to warrant a read beyond the headline. Only 54% of older patients who presented to Australian emergency departments in 2023–24 received an inpatient bed within eight hours — down from 75% just five years earlier. Older patients waiting more than 24 hours increased 3.5-fold over the same period, from 15,084 to 53,510 per year.

This is not a marginal deterioration. It is a trajectory moving sharply in one direction, against the grain of what the community expects from a high-income country with universal healthcare coverage.

What the data shows

The numbers frame the problem clearly. Older ED presentations rose 16% over five years while younger presentations rose 4%. Every jurisdiction except the ACT saw more older patients waiting beyond the eight-hour benchmark. ACEM president Dr Peter Allely has been direct: “Australia’s health system and its health workforce are just not equipped for this demographic change.”

The immediate driver is population structure. Nearly one in five Australians will be 65 or older by 2030. The ACEM report does not frame this as a surprise — it frames it as a planning failure. The demographic trajectory has been visible for decades. The infrastructure, workforce, and integration changes required to meet it have not kept pace.

Tasmania provides a sharper look at what this means at the ward level. State reporting describes an 89-year-old who waited almost 48 hours in a corridor. The image is extreme. The problem it illustrates is not.

Both-and: a genuine system problem, with a general practice dimension

The both-and framing: this is a systems failure that no single intervention in general practice can fix — and general practice is specifically named in ACEM’s list of solutions.

ACEM’s recommendations include better integration between hospitals and aged care, funding investment, and improved access to general practitioners. That third point is not rhetorical. The relationship between GP access and avoidable ED presentations is reasonably well-documented: patients without a regular GP, patients with poorly managed chronic conditions, and patients discharged from aged care without adequate community follow-up all end up at emergency departments at higher rates.

The both-and is this: GPs cannot close the gap in inpatient bed capacity, and the chronic underfunding of aged care and hospital infrastructure is a government responsibility. At the same time, consistent GP management of the conditions that drive older patients to EDs — heart failure, COPD, UTIs, falls-related injury, delirium — is one of the few levers that can reduce demand on a system that is demonstrably not coping.

The planning problem starts earlier than you think

For a 45-year-old woman whose parents are in their mid-seventies, this report is not abstract. It describes the system her parents will enter when the next hospitalisation arrives — and the data suggests the system is less prepared to receive them than it was five years ago.

It also raises a planning question for her own future. General practice is most protective when the relationship has continuity. Older patients who are managed well — whose hypertension, diabetes, and respiratory disease are followed closely, whose medications are reviewed, whose advance care preferences are documented — navigate the aged care and hospital systems with greater agency and fewer crises. The compounding benefit of that kind of care starts now, not at 75.

2 cents

Three things that general practice can actually do in response to this report:

Know your older patients’ trajectory. The 75+ health assessment (MBS item 703) provides a structured point of entry for identifying functional decline, polypharmacy risk, and unmet care needs before a crisis sends someone to an ED. Uptake remains below potential.

Plan around transitions. Older patients discharged from hospital without a GP follow-up within a week have substantially higher readmission rates. A brief post-discharge review — whether by phone or face-to-face — closes a gap that the hospital system often cannot close for itself.

Document advance care preferences. A patient arriving at an ED without a documented advance care plan, or with a plan that is not accessible to the emergency clinician, faces a system making decisions without her voice in the room. That is a clinical task that can be completed well before a crisis, and it belongs in general practice.

The ACEM report describes a system in structural distress. It does not describe one that is broken beyond the reach of general practice action. The two are not in tension.

Verdict: yes — the data is real, the trajectory is clear, and the general practice response is concrete and available now.