Disease spectrum and outcomes among elderly patients in two tertiary hospitals in Dar es Salaam, Tanzania
Autoři:
Basil Tumaini aff001; Patricia Munseri aff001; Kisali Pallangyo aff001
Působiště autorů:
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
aff001
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0213131
Souhrn
Background
There has been an increase in the number of individuals aged ≥60 years in Tanzania and in sub Saharan Africa in general due to improved survival. However, data is scarce on the disease burden and outcomes following admission in this population. We herein describe the pattern of diagnoses, outcomes and factors associated with the outcomes among elderly patients admitted at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) medical wards.
Methodology
From October to December 2017, we consecutively enrolled patients aged ≥60 years (elderly) admitted to the MNH and JKCI medical wards. The ICD 10 was used to code for disease diagnosis at discharge or death. The Modified Barthel index was used to assess for functional activity on admission and at discharge.
Results
We enrolled 336 (30.1%) elderly participants out of 1301 medical admissions. The mean age ± SD was 70.6 ± 8.9 years; 169 (50%) were female and the average number of diagnoses was 2 per participant. The most common diagnoses were: hypertension 151 (44.9%), stroke 106 (31.5%), heart failure 62 (18.5%), pneumonia 60 (17.9%), diabetes mellitus 58 (17.3%) and chronic kidney disease 55 (16.4%). The median duration of hospital stay was 5 (IQR 3–10) days and in-hospital mortality was 86 (25.6%), 56 (65%) deaths were due to non-communicable diseases and 48 (55.8%) deaths occurred within 72 hours of hospitalization. A modified Barthel score ≤20 on admission was associated with an OR 15.43 (95% CI: 7.5–31.7, p<0.001) for death.
Conclusion
Elderly patients constituted a significant proportion of medical admissions at MNH and JKCI with high in-hospital mortality. A modified Barthel index score ≤20 during admission is associated with mortality and can be used to identify patients requiring special attention.
Klíčová slova:
Hospitals – Activities of daily living – HIV diagnosis and management – Geriatrics – Elderly – Hypertension – Chronic kidney disease – Heart failure
Zdroje
1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP/248.
2. Matuja WB, Ndosi NK. The elderly patients as seen at Muhimbili Medical Centre, Tanzania. East African Medical Journal. 1994;71(3):142–5. 7956858
3. McLigeyo SO. The pattern of geriatric admissions in the medical wards at the Kenyatta National Hospital. East African Medical Journal. 1993;70(1):37–9. 8513726
4. Sanya EO, Akande TM, Opadijo G, Olarinoye JK, Bojuwoye BJ. Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin. Afr J Med Med Sci. 2008;37(4):375–81. 19301716
5. Akinyemi RO, Izzeldin IM, Dotchin C, Gray WK, Adeniji O, Seidi OA, et al. Contribution of Non communicable Diseases to Medical Admissions of Elderly Adults in Africa: A Prospective, Cross‐Sectional Study in Nigeria, Sudan, and Tanzania. Journal of the American Geriatrics Society. 2014 Aug 1;62(8):1460–6. doi: 10.1111/jgs.12940 25041242
6. Niccoli T, Partridge L. Ageing as a risk factor for disease. Current Biology. 2012;22(17):R741–52. doi: 10.1016/j.cub.2012.07.024 22975005
7. Davies EA, O'mahony MS. Adverse drug reactions in special populations–the elderly. British journal of clinical pharmacology. 2015 Oct;80(4):796–807. doi: 10.1111/bcp.12596 25619317
8. Onwuchekwa AC, Asekomeh EG. Geriatric admissions in a developing country: experience from a tertiary centre in Nigeria. Ethnicity & Disease. 2008;19(3):359–62.
9. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke. 2011;42(4):1146–51. doi: 10.1161/STROKEAHA.110.598540 21372310
10. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of clinical epidemiology. 1989;42(8):703–9. doi: 10.1016/0895-4356(89)90065-6 2760661
11. ICD-10 Version: 2016 Available at: https://icd.who.int/browse10/2016/en
12. United Republic of Tanzania. National Bureau of Statistics, Ministry of Finance, Dar es Salaam; and Office of the Chief Government Statistician, Ministry of State, President’s Office, State House and Good Governance Zanzibar. National Population Projections. 2018. pp. 53–4. Available from: http://www.nbs.go.tz
13. Mtei LN, Pallangyo P. HIV infection in elderly medical patients. East African Medical Journal. 2001;78(3):144–7. doi: 10.4314/eamj.v78i3.9081 12002055
14. Naghavi M, Forouzantar MH. Burden of non-communicable diseases in sub Saharan Africa in 1990 and 2010: Global burden of diseases, injuries and risk factors study 2010. Lancet 2013; 381: S95.
15. National Bureau of Statistics (NBS) and Office of Chief Government Statistician (OCGS) Z. The 2012 Population and Housing Census: Basic Demographic and Socio- Economic Profile; Key Findings. Dar es Salaam, Tanzania: NBS and OCGS.; 2014.
16. The United Republic of Tanzania National Bureau Statistics. Tanzania population and Housing Census 2002 Analytical Report [Internet]. 2006 [cited 2017 Mar 9]. Available from: http://www.nbs.go.tz/nbs/takwimu/references/2002popcensus.pdf
17. WHO 2014. WHO | Global status report on noncommunicable diseases 2014. [Internet]. World Health Organization; 2015 [cited 2018 May 9]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
18. Karam Z, Tuazon J. Anatomic and physiologic changes of the aging kidney. Clinics in Geriatric Medicine. 2013;29(3):555–64. doi: 10.1016/j.cger.2013.05.006 23849007
19. Cheitlin MD. Cardiovascular physiology—changes with aging. The American Journal of Geriatric Cardiology. 2003;12(1):9–13. 12502909
20. Ungvari Z, Kaley G, De Cabo R, Sonntag WE, Csiszar A. Mechanisms of vascular aging: new perspectives. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2010;65(10):1028–41.
21. Shen Y, Cai R, Sun J, Dong X, Huang R, Tian S, Wang S. Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis. Endocrine. 2017;55(1):66–76. doi: 10.1007/s12020-016-1014-6 27477292
22. Yu XQ. Hypertension is an independent risk factor for progression of chronic kidney disease. ZhonghuaNeiKeZaZhi [Internet]. 2009 Jun [cited 2018 Feb 1];48(6):443–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19954033
23. Mmbando BP, Vestergaard LS, Kitua AY, Lemnge MM, Theander TG, Lusingu JP. A progressive declining in the burden of malaria in north-eastern Tanzania. Malaria Journal. 2010;9(1):216.
24. Mboera LE, Mazigo HD, Rumisha SF, Kramer RA. Towards malaria elimination and its implication for vector control, disease management and livelihoods in Tanzania. MalariaWorld Journal. 2013;4(19).
25. Government of Tanzania, Ministry of Health, Community Development Gender, Elderly and Children and the Ministry of Health Zanzibar. Tanzania HIV Impact Survey (THIS 2016–17) [Internet]. Dar es Salaam; 2017 [cited 2018 Jun 5]. Available from: http://www.nbs.go.tz/nbs/takwimu/this2016-17/Tanzania_SummarySheet_English.pdf
26. Adebusoye LA, Owolabi MO, Kalula SZ, Ogunniyi A. All-cause mortality among elderly patients admitted to the medical wards of hospitals in Africa: A systematic review. Nigerian Journal of Health Sciences. 2015;15(1):45–51.
27. Gordo F, Castro C, Torrejón I, Bartolomé S, Coca F, Abella A. Functional status as an independent risk factor in elderly patients admitted to an Intensive Care Unit. Revista Espanola de Geriatria y Gerontologia [Internet]. 2018 [cited 2018 May 1]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29678257
28. Biagi P, Gussoni G, Iori I, Nardi R, Mathieu G, Mazzone A, et al. Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI “CONFINE” Study. International Journal of Cardiology. 2011;152(1):88–94. doi: 10.1016/j.ijcard.2011.02.025 21397348
29. Formiga F, Chivite D, Conde A, Ruiz-Laiglesia F, Franco ÁG, Bocanegra CP, et al. Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients—the prospective RICA study. International Journal of Cardiology. 2014;172(1):127–31. doi: 10.1016/j.ijcard.2013.12.169 24452223
Článok vyšiel v časopise
PLOS One
2019 Číslo 10
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Těžké menstruační krvácení může značit poruchu krevní srážlivosti. Jaký management vyšetření a léčby je v takovém případě vhodný?
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- Correction: Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study
- Combining CDK4/6 inhibitors ribociclib and palbociclib with cytotoxic agents does not enhance cytotoxicity
- Experimentally validated simulation of coronary stents considering different dogboning ratios and asymmetric stent positioning
- Risk factors associated with IgA vasculitis with nephritis (Henoch–Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis