Hospital use by the extremely elderly (nonagenarians): a two-year study

Patterns of Health and Social Services Utilization

Utilization of an array of health and social services from formal and informal sources is studied here 1) to identify profiles of services utilization and 2) to predict the location of elderly in these profiles by a set of independent variables such as the sociodemographic characteristics of the elderly, their physical and mental health status and the density of their social support network. Two samples of non-institutionalized elderly living in two middle-sized towns were drawn from the universal old-age Canadian pension scheme. Their utilization of hospital, medical and pharmaceutical services was assessed, and their use of services for help with adivities of daily living was measured by a set of six indicators. A cluster analysis was run to identify profites of services utilization, and a discriminant analysis used the profiles as the criterion to be predicted by a set of variables. Five profiles of utilization were obtained; four of them identified elderly with very few experiences of services utilization and a fifth, a low number of elderly with utilization of all of the services listed in this study. Most of the elderly were users of a small subset of medical and social services. The location of elderly in the profiles was predicted by physical health status, coresidence and income. These results show that health and social services from both formal and informal sources are utilized by elderly. It is suggested that new types of formal agencies which consider the simultaneous delivery of social and health services will succeed inasmuch as they have the ability to interact with a system of informal care.

Influence of acute exacerbation of chronic obstructive pulmonary disease or congestive heart failure on functional decline after hospitalization in nonagenarian patients

BACKGROUND: The functional decline that follows hospitalization may be especially important in frail populations such as nonagenarians. The present study examined the functional decline among nonagenarians admitted because of exacerbations of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). METHODS: A prospective cohort study was performed on two groups of patients who were distinguished by diagnosis in two tertiary academic medical hospitals. Sixty nonagenarian patients, admitted because of exacerbation of COPD (n=30) or CHF (n=30), were evaluated at admission, upon discharge, and 3 months post-hospitalization. The Barthel Index (BI) was used to assess functionality. The outcome we were interested in was functional decline 3 months after hospital discharge. RESULTS: The inpatient mortality rate was 10%. Overall functional status at discharge, as compared with that before admission, declined in all 54 surviving patients (p<0.001). At the 3-month follow-up, 37 patients were evaluated; a decline in their BI persisted in 60% of them. We did not find significant differences, either upon discharge or at 3 months post-hospitalization, in the decrease in BI rate between COPD patients and CHF patients. CONCLUSIONS: The fact that the underlying disease does not induce differences in the functional outcome of nonagenarians reinforces the importance of using a comprehensive approach at admission and after discharge for all frail patients.

[Evaluation of functional capability after hospital admission of nonagenarian patients]

BACKGROUND

Hospitalisation in nonagenarians patients may causes functional decline.

PATIENTS AND METHOD

The study sample included all nonagenarians patients admitted during three months in two teaching hospitals.

RESULTS

We studied 125 patients (24 [19%] died). In the remaining 101 patients the previous Barthel index (BI) was 75, at admission 33 (p < 0.0001), and at discharge 43 (p < 0.001). The decline in BI at discharge was remarkable ( 32; p < 0.0001) and persisted after 3 months (12, p < 0.003).

CONCLUSION

After three months of hospitalisation in nonagenarians patients persist a functional decline.

Use of inpatient hospital services by people aged 90-99 years

OBJECTIVE

To examine the use of inpatient hospital services by people aged 90-99 years.

DESIGN

Retrospective case note review.

SETTING

Flinders Medical Centre, a 516-bed university teaching hospital in Adelaide, South Australia.

PATIENTS

All patients aged 90-99 years on the separation register for 1995.

MAIN OUTCOME MEASURES

Patient demographic characteristics, principal diagnosis, length of hospital stay and outcome, including destination at discharge.

RESULTS

In 1995, 317 separations involved 214 patients aged 90-99 years; 148 patients (69%) were admitted to hospital once, 43 (20%) twice and 23 (11%) three times or more. In 54% of separations, patients came from the community, and these were less likely to be emergency admissions (72%) than were admissions from hostels (87%) and nursing homes (93%). Patients had a wide range of acute medical and surgical problems and a median of five documented comorbidities. Patients survived to leave hospital in 290 separations (91%) and returned directly to their previous living circumstances in 212 (67%). Median hospital stay was 5.0 days, and in 25% of separations stay was one day or less. Patients admitted under the care of geriatricians had more emergency admissions (98%) and longer mean hospital stays (8.9 days) than those admitted under surgeons (69%; 5.9 days) or other physicians (66%; 5.0 days).

CONCLUSION

Despite the acute nature of their illnesses and their multiple medical problems, most hospitalised nonagenarians in this study returned directly to their previous living circumstances after short hospital stays.

Use of community support services by elderly patients discharged from general medical and geriatric medical wards

This descriptive study examines the use of community support services by elderly persons discharged from general and geriatric medical wards of a large acute care British teaching hospital. A convenience sample of 40 patients were interviewed at 6-week intervals over a 3-month period about their need for and use of community support services. The type of ward from which patients were discharged did not influence the use of nursing, homemaker, physician, or warden/community visitor services, hospital day care, or meals-on-wheels. Patients who used the largest number of community services, and were the most frequent users of all available services, were those who, because of their fragility, died or were readmitted to hospital within 6 weeks of discharge. All families interviewed identified a need for more information about their elderly members' illnesses and prescribed medical regimes.