Survey of major chronic iIlnesses and hospital admissions via the emergency department in a randomized older population in Randwick, Australia

Abstract

Objective: To find out if patients with chronic illnesses living in the community are at risk of unplanned hospital admissions through emergency departments; what types of chronic illnesses may be putative risk factors; and if an increase in the number of chronic illnesses may be associated with increased risk. Methods: The survey included the completion of a standardized questionnaire for medical illnesses in a random sample of older people dwelling in the community and analysis of admission records to our hospital. The principal diagnoses for admissions were recorded. The risk factors for admissions were analysed. Results: Five hundred and twenty‐six (239 men and 287 women) people aged 55 years and over were interviewed. Musculoskeletal disorders, hypertension, gastrointestinal disorders and ischaemic heart disease were the most frequently reported of the chronic illnesses surveyed. A total number of 70 people from the survey group with a total of 115 admissions through emergency departments were recorded. Using logistic regression model, hypertension, ischaemic heart disease and age were found to be risk factors for emergency admissions amongst this group of community‐dwelling residents. The ratios were 2.03 (95% confidence interval (CI): 1.2–3.44), 2.02 (95% CI: 1.16–3.49) and 1.05 (95% CI: 1.02–1.09), respectively. Furthermore, multiple (three or more) chronic illnesses were found to be a strong predictor of hospital admission via emergency department (chi‐square = 16.647, DF = 1, P‐value < 0.001). Conclusion: We conclude that there was significant association between multiple chronic diseases and emergency admissions for older people. Of these, hypertension and ischaemic heart disease were found to be significant predictors. Age per se was found to be of borderline significance.

Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

“…Die Inanspruchnahme stationärer Versorgungsleistungen durch ältere multimorbide Patienten wurde größtenteils anhand folgender Endpunkte untersucht: Zahl der Krankenhauseinweisungen [17,20,21,22,23,24,25], der Tage oder Näch-te im Krankenhaus [16,21,22] und der Notaufnahmen [26,27,28,29] innerhalb eines Jahres sowie der ungeplanten Wiedereinweisungen innerhalb eines Monats oder Jahres [30,31,32]. Die gesamte Evidenz entstammt der ausländischen Literatur.…”

“…2). In einer ebenfalls mit administrativen Daten durchgeführten schwedischen Studie [23] hatten Patienten mit drei oder mehr Krankenhauseinweisungen signifikant mehr chronische Erkrankungen (3,45) [30,31,32] oder Notaufnahmen im Allgemeinen [26,27,28,29] betrachtet haben, diesbezüglich einen signifikanten positiven Zusammenhang.…”

Multiple conditions: exploring literature from the consumer perspective in Australia

“…A similar study was carried out in Germany where age and multimorbidities were found to have strong impacts on use of services 25. Unplanned hospital admissions were discussed in relation to comorbidities and the elderly . Upshur et al .…”

“…Much of the literature concentrates on multiple chronic conditions and the elderly reflecting health policy concerns. Given the association between multiple conditions and unplanned emergency department, admissions in the elderly such a concern requires addressing. For those who are not elderly but have multiple conditions, unplanned hospital admissions are also an issue.…”

How well can signs and symptoms predict AMI in the Malaysian population?

“…In a review of sudden deaths in England, it was found that for cases involving myocardial tissue, death was ascribed to ischaemic heart disease in 82.4% of cases [3]. In the elderly, hypertension and ischaemic heart disease have been found to be significant predictors of emergency room admissions [4].…”