1
|
Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
Collapse
|
2
|
Mane G, Alkhouri H, Dinh M, McCarthy S. One hundred and counting: Centenarian use of emergency departments in New South Wales. Emerg Med Australas 2019; 31:626-631. [PMID: 30866166 DOI: 10.1111/1742-6723.13259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/12/2018] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study ED utilisation by people aged 100 years and over with a focus on patient demographics, reasons for presentation and patient flow factors. METHODS This is a retrospective descriptive analysis of linked ED Data Collection Registry for presentations to New South Wales (NSW) EDs over a 5 year period. Patients were included if they presented to an ED and were aged 100 years and over at the time of presentation. Demographics, triage category, presenting problem, ED length of stay, disposition and ED re-presentation were determined for this age group. RESULTS A total of 4033 presentations to 115 NSW EDs during 2010-2014 were analysed. We found that 78% of the patients were females and 76% still living at home. This group were the second most common age group to present to ED, after the 90-99 year age group, with 87% arriving via ambulance. Most presentations were triaged as a category 3 or 4, with the most common presenting problem being because of injury (28.5%) followed by respiratory disease (11.4%) and cardiovascular disease (10.0%). Overall, 64% required hospital admission and the average length of stay for all patients was 5.7 h. CONCLUSIONS Centenarians ED presentations are increasing over time with injuries as the most common reason for presentation. Most patients have prolonged ED length of stay and many require hospital admission. Early streaming of these patients through specialised geriatric assessment units may be more appropriate to reduce the demand on EDs and improve patient care. Models that facilitate rapid access to supported living arrangements and improved advanced care planning may be more realistic for many centenarians and different models of care need to be considered for this age group.
Collapse
Affiliation(s)
- Gabrielle Mane
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.,Emergency Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally McCarthy
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Gast C, Leveau M, Valentian M, Mewasing I, Dautheville S, Bouvard E, Ray P. Caractéristiques des patients centenaires consultants dans un service d’accueil et d’urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Le nombre de consultations des personnes âgées aux urgences est en constante augmentation. Cette étude avait pour but d’évaluer les caractéristiques des patients centenaires, consultants dans un service d’accueil d’urgences et leur devenir.
Patients et méthode : Etude monocentrique, rétrospective, sur la période de janvier 2012 à mars 2015, incluant tous les centenaires consultants aux urgences d’un hôpital universitaire. Les données ont été comparées à une première période d’étude 10 ans auparavant (2002-2005) (travail déjà publié).
Résultats : Durant cette période, 21 550 (14%) des patients ayant consulté avaient plus de 75 ans, et 129 (<1%) patients avaient 100 ans et plus. Sept dossiers incomplets ont été exclus, et un total de 122 dossiers a donc été retenu pour l’étude. L’âge moyen des patients était de 102 +/- 1,4 ans. En 2002-2005, 81% des patients centenaires ont été adressés au SAU après un premier contact de leur médecin traitant ou du médecin de garde, contre 56% en 2012-2015 (p<0,001). Les principaux motifs de consultation aux urgences restaient les chutes (42% vs. 39%, p=0,66), suivies des symptômes respiratoires (22% vs. 21%, p=0,88). La durée moyenne de séjour a diminué de 10 jours à 7 jours, entre les 2 périodes. Le taux d’hospitalisation restait stable (57% vs. 67%, p=0,06), ainsi que la mortalité hospitalière (24% sur les deux périodes, p=0,95).
Conclusion : Cette étude souligne la spécificité des besoins des patients centenaires aux urgences, en matière de prise en charge non programmée.
Collapse
|
4
|
Tettamanti M, Marcon G. Cohort profile: 'Centenari a Trieste' (CaT), a study of the health status of centenarians in a small defined area of Italy. BMJ Open 2018; 8:e019250. [PMID: 29439076 PMCID: PMC5829861 DOI: 10.1136/bmjopen-2017-019250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Centenarians, a segment of the population which some 50 years ago comprised only a few individuals, now count thousands in many countries, and demographic projections forecast that this growth will continue. The study of this new population will give us new information on extreme longevity and help prepare for their health and social needs. The aim of the Centenari a Trieste study is to describe the health and health service use by centenarians, with specific focus on cognitive status. PARTICIPANTS This is a population-based study of centenarians living in the province of Trieste (Italy), a small area with a high prevalence of centenarians and a close network of health and social services, which makes it possible to conduct a study. Consenting individuals were visited by a clinician, tested by neuropsychologists and also gave a sample of their blood. Administrative data were retrieved as well. FINDINGS TO DATE Of the 163 centenarians, 70 could be contacted and participated in the study. The main reasons for non-participation were impossibility to contact the subject (70) and death (20). Centenarians were mostly women (90%), tended to live in a nursing home (60%) and were generally severely functionally impaired (Barthel Index <50: 61%). Data from the administrative database showed that about one out of five needed hospitalisation in the preceding year and more than three out of four had at least one drug prescription. FUTURE PLANS In 2017, we started a new wave of the study enrolling people who had just become centenarian and reassessing subjects already seen; we hope to extend this recruitment in the next years. Subjects are now examined also by cardiologists and dental specialists. We are collecting further different biological specimens to investigate new hypotheses on the cognitive function of the centenarians.
Collapse
Affiliation(s)
- Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gabriella Marcon
- ASUITS - Dipartimento di Scienze Mediche Chirurgiche e della Salute (DSMCS), University of Trieste, Trieste, Italy
- Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
| |
Collapse
|
5
|
Martín-Sánchez FJ, Fernández-Alonso C, Hormigo AI, Jiménez-Díaz G, Roiz H, Bermejo-Boixareu C, Rodríguez-Salazar J, Fernández Pérez C, Gil-Gregorio P. [Clinical profile and 90-day mortality in centenarian patients attended in emergency departments]. Rev Esp Geriatr Gerontol 2016; 51:196-200. [PMID: 26916908 DOI: 10.1016/j.regg.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED). METHODOLOGY This was an observational, retrospective, multicentre cohort study including patients >99years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality. RESULTS The study included 209patients aged 101years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index≥3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI=0.97-6.04; P=.059), emergency care in the previous 3months (OR 4.08 95% CI=1.26-13.16; P=.019) and the hospitalization by index event (OR 8.63 95% CI=3.25-22.9; P<.001) and this model had an area under ROC curve of 0.776 (95% CI=0.70-0.85; P<.001). CONCLUSIONS Centenarian patients attended in ED had a significant frailty and one in three cases died in the first 90days after being attended, and this was associated with male sex, emergency care in the previous 3months, and hospitalisation.
Collapse
Affiliation(s)
| | | | | | - Gregorio Jiménez-Díaz
- Servicio de Urgencias, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Honan Roiz
- Servicio de Urgencias, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | | | | |
Collapse
|
6
|
Dotchin CL, Gray WK, Gaskin E, Hartley S, Walker RW. Frequency, nature and outcomes of hospital admissions in centenarians in an area of North-East England. Geriatr Gerontol Int 2015; 16:969-75. [PMID: 26311143 DOI: 10.1111/ggi.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
AIMS There are few data on the use of hospital services by centenarians living in the UK. In the present study, we recorded the frequency, nature and outcomes of hospital admissions in centenarians in an area of North-East England. METHODS Data regarding hospital attendance in centenarians in Northumberland and North Tyneside, covered by one National Health Service Trust, were collected. For the years 2010-2013, demographics, frequency of admission and length of hospital stay data were collected. Medical notes for those admitted in 2011 were reviewed, and data extracted relating to diagnosis, medications and past medical history. RESULTS Across the 4 years of the study, there were 349 hospital attendances of centenarians. A total of 264 of these attendances resulted in admission with an overnight stay. In 2011, there were 107 attendances, 75 of which (in 54 unique patents) resulted in admission and an overnight stay. The unique patients admitted represented 41.5% of the centenarians living in the catchment area. The most common primary reason for admission in centenarians was respiratory tract infection, though falls were a primary or secondary reason for admission in 41.3% of centenarians. There were 11 in-hospital deaths in 2011, and a further seven deaths within 30 days of discharge. The median number of medications taken on admission and discharge was six. CONCLUSIONS Almost half of the centenarians living in the catchment area were admitted to hospital during 2011. Over 25% of admissions either died in hospital or within 30 days of discharge. Geriatr Gerontol Int 2016; 16: 969-975.
Collapse
Affiliation(s)
- Catherine L Dotchin
- Department of Medicine, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Department of Medicine, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Elizabeth Gaskin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Hartley
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Richard W Walker
- Department of Medicine, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|