Recent modifications in the health care system in Italy reduced the number of inpatient care beds and limited the access to outpatient services while the proportion of older persons increased. To assess the burden of these changes on hospital care the characteristics of admissions to 35 acute geriatric wards and 31 internal medicine wards in Italy were studied between 1988 and 1993. All patients admitted during 4 months in 1988, 1 month in 1991 and 4 months in 1993 were enrolled in the study. The appropriateness of admission was assessed by means of the Appropriateness Evaluation Protocol criteria. The Charlson comorbidity index score was used to quantify comorbidity. Between 1988 and 1993, 18,790 patients were studied. The mean age increased from 67.9 +/- 0.2 to 71.7 +/- 0.2 years (p < 0.0001), the mean number of drugs taken during hospital stay increased from 5.2 +/- 0.0 to 5.5 +/- 0.0 drugs (p < 0.0001), the mean Charlson comorbidity index score increased from 1.33 +/- 0.02 to 1.50 +/- 0.03 (p < 0.0001) and the mean length of stay decreased from 17.6 +/- 0.2 to 16.1 +/- 0.2 days (p < 0.0001). The rate of appropriate admissions increased from 68.6% to 85.5% (p < 0.0001). Consistent results were found when the data were stratified according to gender and type of ward. It was concluded that in Italy, concurrently to an increased load of hospital care, inappropriate admissions diminished over time. These data show that the need for geriatric care is increasing.