Introduction: Ageing is a phenomenon that has preoccupied the minds
of humankind for generations but it was only in the twentieth century that
medical care dedicated to the elderly was created. The field of Geriatric
Medicine has grown in South Africa and globally, to be recognized as a
subspecialty of Internal Medicine in its own right. Physiological changes in the
elderly impact on the increased prevalence of non–communicable diseases
and the raised burden of disease in this age group. The altered spectrum of
diseases in this age group and atypical manifestations of these conditions
make geriatric health care truly unique. In spite of the recognition that the
elderly have specific medical conditions, a dedicated health care policy to
improve geriatric health care is yet to be developed In South Africa. For such
a policy to be created, more needs to be known about the causes of mortality
and morbidity that contributes to the burden of disease in this age group.
Method: A retrospective chart review was conducted on 218 admissions
of persons aged 60 years and over to the medical wards of King Edward VIII
Hospital. This is a regional facility in Durban, South Africa, that provides
mainly secondary and tertiary levels of care. An ethical waiver was obtained
from the Biomedical Research Ethics Committee of the University of KwaZulu-
Natal and all data sheets were de-identified. A structured data extraction
sheet was used to record demographic and clinical data, including the
admission diagnoses, presence of concomitant diseases, management and
complications of some of these diseases, length of hospitalization and
outcome of admission.
Results: The study population comprised 191 patients aged 60 years and
over, with a mean age of 70.5 ± 7.4 years (range 60 – 90 years). The patients
were predominantly female (61.3%) and Black African (83.8%). While the
majority of patients had only 1 admission, most were admitted with multiple
diagnoses. Four or more diagnoses were recorded for 58.1% of the patients,
with 50 patients (26.2%) having four diagnoses and 38 patients (19.9%)
having five diagnoses. A history of current smoking was recorded in 38% of
males and 7.2% females.
Respiratory disease was the most common admission diagnosis (42.7%),
followed by cardiac (42.2%) and renal disease (40.4%). An infection was
present in 116 cases (53.2%) on admission, the commonest being pneumonia
in 71 (61.2%), followed by urinary tract infection in 34 (28%) and septicaemia
in 11 (9.5%).
Cardiovascular disease was the most common underlying chronic disease,
with hypertension being present in 150 patients (68.8%) and cardiomyopathy
in 60 patients (25.5%). Of the patients with hypertension, evidence of end
organ damage was present in 128 patients (85.3%), with hypertensive heart
disease in 97 patients (75.8%), renal disease in 61 patients (47.7%),
cerebrovascular disease in 37 patients (28.91%), hypertensive retinopathy in
11 patients (8.6%) and peripheral vascular disease in 5 patients (3.91%).
The most common risk factors for congestive cardiomyopathy were
hypertension in 55 cases (67%) and diabetes mellitus in 24 cases (40%). In
addition, infection was the most common identifiable precipitating factor for
cardiac failure in 40 % of cardiac failure cases Eleven patients were on
anticoagulant therapy, of which three (27.3%) presented with overwarfarinization.
More importantly, eight of the 17 patients (47%) with atrial
fibrillation were not on anticoagulants.
Neurological disease was present in 27.5% of the admissions with
cerebrovascular disease being the most common (75% of all neurological
cases)
A diagnosis of malignancy was recorded in 13.1% of admissions with the
most common primary site being the lung. In eight patients (32 % of those
with malignancy) there was evidence of metastatic disease.
Men were more likely than women to be admitted with respiratory disease
(22.8% vs. 2.2%, p < 0.0001) such as chronic obstructive airways disease
(57% vs. 34.5%, p = 0.001). Although pneumonia was more common in men
than in women, this did not reach clinical significance (40.5% vs. 28.8%, p =
0.053). In contrast, more women were admitted with arrhythmias (16.5% vs.
6.3%, p = 0.03), congestive cardiac failure (30.2% vs. 15.2%, p = 0.013) and
endocrine diseases (23.7% vs. 12.7%, p = 0.048). Renal disease was more
common in women than in men, but did not reach statistical significance
(44.6% vs. 32.9%, p = 0.060)
In the 191 patients, 64 deaths (33.7%) were recorded during hospitalization.
The mortality rate was found to be significantly higher in patients with
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cerebrovascular accidents, acute renal failure, diabetes mellitus, and infection
(including pneumonias).
Conclusion: This study confirms the high prevalence and disease
burden of non-communicable diseases in older patients, with the majority of
patients having multiple diagnoses on admission. Hypertension and other
cardiovascular diseases were identified as being most common with a high
prevalence of target organ damage. Furthermore, in the patients with
malignancy metastatic disease was common. These findings suggest that
older patients may present late due to a lack of awareness, limited access to
appropriate health care, or lack of adequate treatment and screening
programmes. In addition to the burden of non-communicable diseases
(NCD), infection (particularly pneumonia) emerged as a common cause for
admission and mortality.
These findings confirm the high burden of non-communicable diseases and
their complications in the older population and highlight the need screening
programs to improve detection and better management of these conditions.
Furthermore the association of a high mortality with infections, finding
underscores the need for implementation and adherence to treatment
guidelines, and to develop and adhere to vaccination guidelines.
Furthermore, training of health care personnel at all levels should be
intensified in an attempt to decrease the burden of disease in older persons
and to improve their quality of life. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ukzn/oai:http://researchspace.ukzn.ac.za:10413/5576 |
| Date | January 2011 |
| Creators | Maharaj, Rasha. |
| Contributors | Cassim, Bilkish. |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
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