Internal and geriatric medicine: an alliance for the challenges of the elderly

C-Reactive Protein and Albumin Levels as Useful Tools for Predicting In-Hospital Outcomes in Polish Nonagenarians

Purpose

The admissions of nonagenarians to internal medicine wards are rising. The aim of this study was to analyse the causes of ward admission and blood and renal parameters as potential mortality predictors in this age group.

Patients and Methods

Out of 1140 patients, 111 nonagenarians aged 90+ admitted to the Internal Medicine Ward in one general hospital in Poznan in 2019 were studied. Medical records of these patients were analysed to find factors attributable to the hospitalisation.

Results

The leading causes of admission were infections and cardiovascular diseases, and the main causes of death were cardiovascular diseases. Elevated C-reactive protein (CRP) level was a statistically significant death predictor. Equally, decreased albumin level was found to be a mortality predictor. No such relationships were obtained for haematological or renal parameters.

Conclusion

Our study uniquely analysed a relatively large group of hospitalised nonagenarians and identified those who need particular attention in the ward by identifying those with the highest risk of death. CRP and albumin levels may serve as useful indicators of in-hospital mortality in this age group.

Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.

Characteristics and outcome in nonagenarians admitted in general internal medicine and other specialties

To describe the characteristics of nonagenarians admitted to the surgical and medical divisions at a tertiary hospital and compare them with nonagenarians admitted to other hospital care services.

METHODS

A retrospective study of all hospital discharge episodes via the registry of the Basic Minimum Data Set at the Hospital General Universitario de Alicante from January 2007 until December 2011.

RESULTS

Of the 165,870 hospitalizations, 2461 (1.5%) were nonagenarians. The highest number of admitted nonagenarians was in the Division of General Internal Medicine (DGIM) (n=751), followed by the short stay unit (SSU) (n=633). The rate of nonagenarians per 100 admissions to the DGIM was 10.2, significantly higher than that of those admitted to the SSU (6.2) (p<0.001), the service of orthopedic and trauma surgery (2.2) (p<0.001), and other specialties. Females comprised 64.8% of the nonagenarians. Mortality was 17% for the nonagenarians admitted, while for those admitted to the DGIM it was 27.7%. Those hospitalized in the SSU had a lower risk of death during hospitalization (8.1%) (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.16-0.32) and a greater risk of being admitted for diseases and disorders of the circulatory system (OR: 1.58, 95% CI: 1.22-2.05), particularly for heart failure and shock (OR: 1.82, 95% CI: 1.30-2.53), and being discharged with home hospitalization (OR: 8.05, 95% CI: 5.5-11.8).

CONCLUSIONS

Nonagenarian patients represent a tenth of those admitted to the DGIM. The profile of nonagenarians admitted to the DGIM is different from other hospital services. Hospital mortality for nonagenarians admitted to the DGIM is high and superior to other hospital services.