Medical adverse events in elderly hospitalized patients: A prospective study

Abstract

OBJECTIVES:To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates.METHODS:This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events.RESULTS:The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41±15.08 days versus 10.91±7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR = 1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30).CONCLUSION:Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

Fatores relacionados à ocorrência de eventos adversos em pacientes idosos críticos

“…The results of this study with respect to demographic and clinical variables of ICU elderly corroborate evidence from other investigations related to this type of participants (3,6,(8)(9)12,(22)(23)(24) . Most were males (60.6%), slightly above the results of studies that found more homogeneous distribution between genders, with prevalence of 56.3% (10) and 54.10% (22) .…”

“…Most were males (60.6%), slightly above the results of studies that found more homogeneous distribution between genders, with prevalence of 56.3% (10) and 54.10% (22) . Regarding age, similar results are found in the literature, with means ranging from 72.2 to 83.4 years (6,(8)(9)23) . The dilemma of the elderly age in the ICU and therefore decisions on the costeffectiveness of the treatment have been a subject of controversy in the literature.…”

Prevalência De Eventos Adversos Entre Idosos Internados Em Unidade De Clínica Cirúrgica

“…O paciente idoso, no contexto hospitalar, representa um grupo altamente exposto à ocorrência de eventos adversos durante a prática assistencial, seja pela recuperação mais lenta, que prolonga o tempo de internação, seja pelo tipo de cuidado que necessita, seja, ainda, pela fragilidade pró-pria do ciclo de vida (2)(3)(4) . Entende-se evento adverso como um incidente decorrente da atenção à saúde, que resultou em algum tipo de dano ao paciente, podendo ser físico, social ou psicológico, o que inclui doença, lesão, sofrimento, incapacidade ou morte (5) .…”

“…Em estudos realizados em hospitais brasileiros, portugueses e canadenses, os eventos adversos mais descritos durante a hospitalização de idosos são infiltração, obstrução ou flebite em acesso venoso periférico, lesão por pressão, perda de sonda nasoenteral, queda e eventos relacionados à administração de medicamentos (2,4,7) . Revisão sistemática que avaliou a ocorrência de eventos adversos cirúrgicos evidenciou que os erros durante as atividades não cirúrgicas são mais frequentes do que os erros na técnica cirúrgica (8) .…”

Vital Signs Measurement: An Indicator of Safe Care Delivered to Elderly Patients

“…[16][17][18] Studies show that elderly individuals are more susceptible to incidents, 17,[19][20][21] and also report the occurrence of events after incomplete recording of vitals signs, [22][23] especially respiratory frequency, which is usually the least frequently documented vital sign. [24][25] One ongoing study addressing records of 260 hospitalizations of elderly individuals in a surgical clinic identified 5,321 incidents, 71% of which involved incomplete recording of vitals, while the non-recording of respiratory frequency (39.4%) also stood out.…”