Introduction & Background
As the standard of living is improving in developing countries like India, there is a huge burden of elderly people in the society. The elderly population (aged 60 years or above) accounted for 7.4% of total population in 2001. For males it was at 7.1%, while for females it was 7.8%.1 The population of the elderly has shown an increase from just 5.6% in 1961 to 7.7% in 2001. By 2050, older people will out number children under the age of 14 years in India.1, 2
Considering the increasing burden of geriatric health and social problems in India, the World Health Organization (WHO) in collaboration with the Government of India carried out a cross-sectional, community-based study of the elderly population 60 years and above at 10 different sites in different states and union territories of India to evaluate the disease burden.3 So to cater the needs of more elderly people efficiently in the society is the need of the hour. As much of the research work is not done on this population of our region, we are conducting the present study on the admitted geriatric patients of the Medicine wards of Bundelkhand Govt. Medical college Sagar, in the duration of 6 months duration (Feb 2019-July 2019)
Aims and objectives of the study
The primary aim of the study is to estimate the morbidity profile of various diseases in geriatric patients admitted in Medicine wards of BMC Sagar, MP. And to access the outcomes of various diseases in terms of number of discharge /DOR/LAMA/Deaths/ Referral to higher centres in the geriatric age group.
Secondary aim of the study is to assist in the planning of better health care facilities for Geriatric patients of Bundelkhand region of Sagar, according to the disease burden of the same in the society, as it is still underprivileged as compared to other states in terms of per capita income and health care facilities.
Materials and Methods
This is a retrospective, observational, study design. The study was conducted on the convenience sample taken from Geriatric patients above the age of 60 yrs, who were admitted in the medicine wards of Bundelkhand Medical College Sagar, MP in the duration of 6 months starting from Feb 2019 to July 2019 after taking proper approval from the ethical committee of BMC Sagar, MP to conduct the study.(IEC/BMC/12/2020).
Exclusion criteria
Patients not registered in IPD of BMC Sagar.
Age below 60 yrs.
Patients whose data/ files were not complete.
All the registered patients who fulfilled the criteria were included in the study. Both the sexes were included. The data were obtained from the MRD of our hospital, and then data examination of medical records of these patients were done & data obtained according to pre decided study proforma. Which included the socio economic and demographic details of patients, presenting complaints on admission, clinical condition on admission & various available investigations and final diagnosis with outcomes of the patient on records. Various comorbidities were also included along with the final diagnosis. All the previous medical records pertaining to specific medical disorder were seen thoroughly. The General examination and systemic examination findings were included. (Which is according to the case records available). Relevant investigations like FBS/ PPBS, Lipid profile, LFT, RFT, TFT, HbA1C, ECG, X-Ray Chest were included. Special investigations like TMT, USG Abdomen, CT Scan/ MRI scan were included where ever available on records. Then the master chart were prepared on Microsoft excel sheet and then data were statistically analysed on SPSS Software version 20. P value of < 0.05 is considered significant. Demographic and clinical informations were determined by descriptive variables. The unpaired two tailed ‘t’ test was used in the statistical study.
Observations & Results
Table 1 - in our study total 970 patients were included, out of which (n=581, 59.9%) were males and (n=389, 40.1%) were females. The ratio of male and female patients was 1.5:1.
Table 1
Number and percentage of Male and Female patients -
|
Gender |
Frequency (n=970) |
Percentage (%) |
|
Male |
581 |
59.9 |
|
Female |
389 |
40.1 |
|
Total |
970 |
100 |
Table 2
Sex distribution in study with age group (60-69, 70-79, 80-89, 90yrs and above)
Table 3
Association of Gender with System involvement -
Table 4
Association of Gender with Diagnosis
Table 5
Distribution according to outcome (Discharge / LAMA/ Death / Referral / Other)
|
Outcome |
Frequency |
Percentage |
|
Discharge |
728 |
75.1 |
|
DOR |
60 |
6.2 |
|
LAMA |
70 |
7.2 |
|
Refer |
6 |
.6 |
|
Abscond |
61 |
6.3 |
|
Death |
45 |
4.6 |
|
Total |
970 |
100 |
Table 6
Outcome accordingly to duration of stay
Figure 1 - Above figure shows that majority of patients belonged to 60 to 69 years of age (60.8%), followed by 24.6% and 10.9% patients belonging to 70 to 79 and 80 to 89 years of age respectively. Only 1.9% patients belonged to >90 years of age.
Table 2 - Mean age of males in our study was 67.6±7.53 years whereas that of females was 68.4±7.98 years. About 61.8% males and 59.4% females belonged to 60 to 69 years of age respectively. The present study observed no significant association between age and gender (p>0.05).
Table 3 - The present study documented that respiratory system was the most commonly involved amongst males (34.4%) whereas cardiovascular system was the most commonly involved amongst females. Test of significance observed statistically highly significant difference between system and gender (p<0.01).
Table 4 - COPD was observed in 20.8% males, whereas in 9.3% females hypertension was the most common diagnosis. The present study documented statistically significant association of diagnosis with gender (p<0.01).
Table 5 - About 75.1% patients were discharged whereas 6.2% patients were discharged on request or LAMA. Death was documented in only 4.6% patients and about 0.6% cases were referred to higher centre.
Table 6 - show Death was observed in 91.1% cases within 7 days of admission whereas about 80.8% cases were discharged within 7 days. The present study documented statistically significant association between duration of stay and outcome (p<0.05).
Discussion
People can be considered old because of certain changes in their activities or social roles as the older people have a limited role in the society. Also old people have limited regenerative abilities and are more prone to disease, syndromes, and sickness as compared to young adults. The medical study of the aging process is called Gerontology and the study of diseases that afflict the elderly is Geriatrics. Old age is not a disease in itself, but the elderly are vulnerable to long term diseases of insidious onset such as cardiovascular illness, CVA, cancers, diabetes, musculoskeletal and mental illnesses. They have multiple symptoms due to decline in the functioning of various body systems.4 Both perceived health and chronic illness are major elements of health status in elderly and there is growing evidence that older people are at risk for multiple comorbidities.5
Geriatric medicine is strongly oriented towards the International Classification of Function and Disability (ICF model) introduced by the World Health Organization (WHO) in 2001.6
In our study Mean age for males was 67.6 ± 7.53 and for females 68.4 ± 7.89. In our study Male: Female ratio is 1.5:1, The present study observed no significant association between age and gender (p>0.05). Which is slightly different with the study done by Vinay at el where number of males were significantly higher.7
In our study highest number of patients were found in 60-69yrs age group in both the sexes, (Male n=359, 61.8%) and (Female n=231, 59.4%) with total number of (n=590, 60.8%). In age group of 70-79yrs Male patients (n=157, 27%) and Female patients (n=99, 25.4%), In age groups 80-89yrs male (n=57, 9.8%) and female (n=49, 12.6%) and above 90yrs there is slightly higher number of females (n=10, 2.6%) as compared to male (n=8, 1.4%). This is similar to the study done by vinay k at el7 where they have found out the highest cases in age group of 70-79yrs (40.0%) and study done by Praveen kumar et al8 where they found highest patients in 60-69yrs (60%).
In our study various system involvement shows respiratory diseases comprises main cause of morbidity among geriatric patients which is comprised of non infective and infective causes both (N=262, 27%), Cardiovascular causes comes on the second place which consist of CAD, Hypertension and Myocardial infarction (n=216, 22.3%), after that Gastrointestinal causes which are comprised of abdominal pain, Dyspepsia, and Gastroenteritis (n=111, 11.4%), Cerebrovascular accidents both cerebral infarction and haemorrhage (n=75,7.7%), Genitourinary causes (n=55, 5.7%), Endocrine causes (n=49, 5.1%) and infections comprised of (n=46, 4.7%). Our findings are consistent with the findings done by vinay K et al7 and in contrast to the study done by Prakash et al4 where they found less cases of respiratory diseases (36%) .
The present study documented that respiratory system was the most commonly involved amongst males (34.4%) whereas cardiovascular system was the most commonly involved amongst females in cases of Hypertension (n=36, 9.3%). Test of significance observed statistically highly significant difference between system and gender (p<0.01).
COPD was observed in 20.8% males whereas in 9.3% females hypertension was the most common diagnosis. The present study documented statistically significant association of diagnosis with gender (p<0.01).
In our study CAD is second most common (13.1%) problem in the elderly population. Hypertension (male n=22,3.8%, Female n=36 9.3%) and among them also it was more common among females. Which is in contrast to other studies done by other authors. Our observation is different with other studies done in different parts of India and world as Hypertension more common among males 42.5% in Jaipur and 40.5% in Shimla, 53.8% in United States and 48% in Canada.8, 9, 10 In a study by Chadha et al11 reported a similar finding as of our study, hypertension as 52.2% and 58.4% among males and females respectively.
Our study is in discordance with the study on hypertension which showed higher prevalence of Hypertension 77.3% (male 74.4%, female 79.6%) among older adults (50 years and older) in South Africa.12
As hypertension is powerful, independent, and modifiable risk factor for the development of all the major clinical manifestations of atherosclerotic cardiovascular disease (Non communicable diseases),13 we should do early diagnosis and treatment of this silent disorder.
In our study majority of the patients were discharged (n=728, 75.1%) after that left against medical advise LAMA (n=70, 7.2%), discharge on request and Absconded (n=60, 6.2%), death rate comprised of (n=45, 4.6%) which is mainly in late age groups 80-89yrs and above 90 yrs.
In our study majority of the patients were discharged in less than 7 days (n=802, 82.7%) and in duration of 7-14 days (n=157, 16.2%) and very less patients are admitted in the medicine wards for more than 21 days (n=11, 1.1%).
Conclusions
This highlights the increasing trend of burden of geriatric health problems in India as there are trends of increasing life expectancy. For a substantial impact on this burden, unique preventive health care strategies specific to the elderly people in the early stages of geriatric patients should be clearly formulated and tested to reduce number of multiple comorbidities and disease complications and life is more convenient and independent at later age groups also. It reduces the cost of treatment as well.
For that the elderly should be encouraged to undergo periodic medical checks at a clinic for routine appraisal of their health status, so as to allow early detection and treatment of their morbidities.
Limitations of study
Some limitations are noted in this study. As Being a retrospective, observational (record based) study design, extraction of final diagnoses from patient’s files with multiple complaints/morbidities could alter the actual prevalence of disease recorded and finally the probability of missing data cannot be excluded.
