Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional Referral Hospital in Southwestern Uganda

Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional... Hindawi Journal of Aging Research Volume 2020, Article ID 6830495, 6 pages https://doi.org/10.1155/2020/6830495 Research Article Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional Referral Hospital in Southwestern Uganda 1,2 3 4 1 Patrick Orikiriza , Godfrey Z. Rukundo , Adrian Kayanja, and Joel Bazira Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda Division of Basic Medical Sciences, University of Global Health Equity, Kigali, Rwanda Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda Correspondence should be addressed to Patrick Orikiriza; patrickorikiriza@gmail.com Received 16 January 2020; Accepted 8 June 2020; Published 29 June 2020 Academic Editor: F. R. Ferraro Copyright © 2020 Patrick Orikiriza et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Recent advances in medicine have caused positive impact on the life expectancy of most countries, resulting in increased older adult population. Aging comes with a number of health challenges. (is study investigated health conditions of older adults at admission and clinical outcomes in a regional referral hospital in southwestern Uganda. Methods. A retrospective study reviewed clinical data of older adult patients admitted between January 2016 and December 2017. Demographic data, cause of admission, length, and outcomes of hospitalization are described. Results. Up to 813 patient files were reviewed. (e patients had been hospitalized to emergency, 371 (45.6%); medical, 355 (43.7%); surgical, 84 (10.3%); psychiatry, 2 (0.3%); and obstetrics and gynecology, 1 (0.1%) wards. (e majority, 427 (52.5%), of the patients were females. Cancer was the most common reason for hospitalization, 130/889 (14.6%), followed by stroke, 94/889 (10.6%); heart failure, 76/889 (8.6%); chronic obstructive pulmonary disease, 56/889 (6.3%); pneumonia, 47/889 (5.3%); and head injury, 45/889 (5.1%), whilst 560 (68.9%) of the hospitalized patients were discharged, 197 (24.2%) died, 18 (2.2%) were referred for advanced care, and 38 (4.7%) escaped from the facility. (e emergency ward had the highest deaths, 101 (51.3%), then medical, 56 (28.4%), and surgical, 39 (19.8%), wards. Mortality of those who died was admitted with stroke, 30 (15.2%), cancer, 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), sepsis, 14 (7.1%), and renal disease, 12 (6.1%). On average, patients were admitted for 5 days (IQR: 3–8). Conclusions. (e high proportion of mortality in this group is worrying and requires further investigations. years. In line with this, the global population of older adult 1. Background people in 2017 was estimated to be 962 million people and Globally, aging populations are emerging at a rapid rate due projected to reach nearly 2.1 billion by 2050 [5], and the to the general increase in life expectancy following advance majority of whom (two-thirds) are in developing in medicine and improved health systems in most countries countries. [1]. (e United Nations Definition of Older Persons includes Old age comes with a number of medical and social individuals aged 60 years and more [2]. challenges that need appropriate and timely interventions In the 2016 WHO report, the global life expectancy [5] to allow active participation in societal development. was estimated at 72 years: 74.2 years for females and 69.8 Indeed, studies have shown that older adult people con- years for males [3]. An annual growth of 3% has been tribute to up to 23% of the total global burden of diseases [6]. noted among the older adult population [4], and many Also, more evidence particularly from developed countries countries are expected to witness a similar trend over the indicate that older adult people are hospitalized more 2 Journal of Aging Research frequently and for a longer period of time than any other age Patient records were maintained at the strictest level of groups as they tend to suffer more severe forms of diseases confidentiality by all members of the study team. On all data that are difficult to diagnose and treat [7, 8]. (is can be collection documents, patient identifiers such as names were highly challenging in low resource settings as it continuously concealed and replaced with unique study identification impacts on their psychological, social, economic abilities and numbers and these records were maintained in locked file that of the health system [9]. cabinets. Even in developed countries where health services are (e study was permitted by the MRRH administration much improved, challenges among older adult people are and approved by the Research Ethics Committee of the common. In one study, it has been reported that one-third of Mbarara University of Science and Technology (18/08-18) as hospitalized older adult patients face more complication by well as the Uganda National Council for Science and the time of discharged, including reduced functional ca- Technology (HS323ES). pacity, than at admission [10]. (e study further reveals that approximately 5% of these die during hospital stay and 20%– 3. Statistical Analysis 30% pass away within one year after hospital discharge. (is indicates that there is a much bigger hidden problem that A case report form comprising of patient demographic data needs to be urgently addressed in order to meet the WHO and clinical conditions was double entered into EpiData and call for the Universal Health Coverage. analyzed using STATA version 13 (Texas, USA). Descriptive Although the WHO attributes most of the health statistics were expressed as proportions in form of tables and problems of the older adults to chronic diseases [11], very graphs. few studies have investigated the specific type of conditions and extent of this burden in low resource countries. To properly address these concerns, it is important to study the 4. Results common conditions so as to establish specific interventions. Uganda is already experiencing an increase in the We reviewed a total of 813 files during the study period population of older adult people as a result of improved life between September and March 2019. Among those with expectancy to 62.5 years [12]. Indeed, in the 2017 WHO gender records, 427 (52.5%) were females and the median report, the older adult people constituted approximately age was 70 (IQR: 65–80). As shown in Table 1, most of the 1425000 (3.3%) of general population and this number is patients were married, 352 (43.3%), with no formal edu- expected to quadruple by 2050 [5]. Despite this increasing cation, 283 (34.8%), and admitted by self-referral, 634 (78%). trend, most health facilities lack dedicated services for this (e majority of patients were admitted to the emergency particular population. Indeed, there is limited evidence on ward, 371 (45.6%), and medical ward, 355 (43.7%). health conditions of hospitalized older adult patients in (e most common reasons for hospitalization were as Uganda. follows: cancer, 130 (14.5%), stroke, 94 (10.5%), heart failure, With accurate data on the profiles of older adult patients 76 (8.5%), chronic obstructive pulmonary disease, 56 (6.2%), and the common diseases that cause their hospital admis- pneumonia, 47 (5.2%), head injuries, 45 (5.0%), diabetes, 43 sions, policies can be enacted to adequately provide necessary (4.8%), hypertension, 36 (4.0%), sepsis, 35 (3.9%), severe human and infrastructural resources required to meet health anemia, 31 (3.4%), and severe malaria, 25 (2.8%), as shown needs of this age-group as emphasized in the holistic ap- in Table 2. proach of the global agenda for sustainable development [5]. While 560 (68.9%) of the hospitalized patients were (is study is among the fast to highlight the health plight discharged, 197 (24.2%) died, 18 (2.2%) were referred for of hospitalized older adult patients in a rural hospital in advanced care, and a large proportion, 38 (4.7%), escaped Uganda. (e study also described the outcomes and com- from the facility (Table 3). mon medical conditions that resulted in mortality among (e emergency ward had the highest deaths, 101 (51.3%), these patients. followed by medical, 56 (28.4%), and surgical, 39 (19.8%), wards (Table 4). Most of the patients died from stroke, 30 (15.2%), cancer, 2. Methods 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), We reviewed all medical records of older adult patients sepsis, 14 (7.1%), and renal disease, 12 (6.1%) (Table 5). As shown in Figure 1, cancer of the oesophagus was the admitted between January 2016 and December 2018, on medical, psychiatry, obstetrics and gynecology, surgical, and most common form of cancer at admission, 34/130 (26.2%), followed by stomach cancer, 20/130 (15.4%), and prostate emergency wards within Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Demographic data, cancer, 19/130 (14.6%). proportion of older adults, health reason, duration, and Most of the people who died from cancer were diagnosed outcomes of hospitalization were described from the rec- at admission with the majority presenting with esophageal ords. (is was an exploratory study, and therefore sample cancer, 5/21 (23.8%), lung cancer, 4/21 (19.1%), prostate size was not estimated. Instead, all the records within two cancer, 3/21 (14.3%), cervical cancer, 2/21 (9.5%), colon years were judged to give reasonable evidence. As a quality cancer, 2/21 (9.5%), stomach cancer, 2/21 (9.5%), and rectal, control, each file was reviewed by two study research as- ovary, and liver cancer, 1/21 (4.8%) each, in that order sistants and verified by the principal investigator. (Figure 2). Journal of Aging Research 3 Table 1: Demographic characteristics of older adult patients at Table 2: Clinical conditions of older adult patients at admission in MRRH. MRRH. Characteristics n (%), n � 813 Disease condition n (%) Age median (IQR) 70 (65–80) Cancer 130 (14.5) Stroke 94 (10.5) Gender Heart failure 76 (8.5) Male 386 (47.5) Chronic obstructive pulmonary disease 56 (6.2) Female 427 (52.5) Pneumonia 47 (5.2) Tribe Head injury 45 (5.0) Munyankole 517 (63.6) Diabetes 43 (4.8) Mukiga 43 (5.3) Hypertension 36 (4.0) Muganda 30 (3.7) Sepsis 35 (3.9) Others 9 (1.1) Severe anemia 31 (3.4) Not indicated 214 (26.3) Severe malaria 25 (2.8) Marital status Fractures 24 (2.7) Single 97 (11.9) Intestinal obstruction 19 (2.1) Married 352 (43.3) Renal disease 18 (2.0) Not indicated 364 (44.8) Hernia 13 (1.4) Level of education Gastric outlet obstruction 12 (1.3) None 283 (34.8) Tuberculosis 11 (1.2) Primary 22 (2.7) Electrolyte imbalance 10 (1.1) Secondary 5 (0.6) Upper gastrointestinal bleeding 10 (1.1) University/tertiary 25 (3.1) Meningitis 9 (1.0) Not indicated 478 (58.8) Liver disease 9 (1.0) Gangrene 8 (0.9) Type of admission Gastroenteritis 7 (0.7) Referral 179 (22.0) Self-referred 634 (78.0) Dementia 5 (0.5) Peritonitis 5 (0.5) Admission ward Alcohol intoxication 4 (0.4) Medical 355 (43.7) Oesophageal stricture 3 (0.3) Psychiatry 2 (0.3) Others 104 (11.7) Obs and gyn 1 (0.1) Total 889 (100) Surgical 84 (10.3) Emergency 371 (45.6) Table 3: Outcomes of older adult patients admitted at MRRH. Finally, an average time of 5 days (IQR: 3–8) of ad- mission was observed among this population. Outcome n (%) Patient was discharged 560 (68.9) Patient referred for advanced care 18 (2.2) 5. Discussion Patient escaped from facility 38 (4.7) Patient died 197 (24.2) (is study investigated the health conditions that caused Total 813 (100) older adult people to be admitted at a regional hospital in a semiurban community of southwestern Uganda. (e study highlights critical issues and eventual outcomes. According predominant causes of hospitalization [15]. Besides diabetes, to our knowledge, this is the first study to bring attention to the main cause for hospitalization in Europe, the other main the heath plight of this particular population. conditions include cardiovascular diseases and pulmonary First, we have shown that close to 1000 older adult people diseases, which are similar to what we observed in this study were hospitalized in this regional hospital within two years. [16]. Indeed, by grouping the health conditions observed, (e male to female ratio was also close to 1, which is similar to cardiovascular diseases such as stroke, heart failure, and what we observed in our previous tuberculosis study among hypertension together contributed up to 29.2% of disease adults aged 18 and above, in the same setting [13]. burden. Another study reported these cardiovascular diseases Secondly, our study has shown that cancer, stroke, heart (30.3%) as the leading contributors to disease burden in older failure, chronic obstructive disease, pneumonia, and head adult people followed by cancer (15.1%) and chronic respi- injury dominated as most common conditions causing ratory diseases (9·5%) [6]. Although different context, the hospitalization. (e raise in the number of cancer cases in the proportions are much similar, indicating that addressing country has been previously described in the general pop- these health challenges could greatly minimize overall risks of ulation [14]. (e rates reported in this study are in tandem hospitalization in many settings. with national figures [12]. Other countries have reported a In the outcome analysis, this study observed an in- different disease spectrum in a similar population. In one of hospital mortality rate of 24.2% while 68.9% were dis- the few African studies, hypertension, heart failure, ischemic charged. Our findings on mortality is much higher than heart disease, and anemia were reported as the most 8.5%, 12%, 16.4%, and 14.9% previously reported in Turkey, 4 Journal of Aging Research Table 4: In-patient outcomes according to the ward of admission. Hospital wards Outcome Medical Psychiatry Obs/gyn Surgical Emergency Total Discharged 276 2 0 40 242 560 Referred 10 0 0 1 7 18 Escaped 13 0 0 4 21 38 Died 56 0 1 39 101 197 Total 355 2 1 84 371 813 Table 5: Antecedent causes of death among older adult patients at 30.00 MRRH. 25.00 Diagnosis made Died, n (%) 20.00 Stroke 30 (15.2) Cancer 21 (10.7) 15.00 Head injury 16 (8.1) 10.00 Heart failure 14 (7.1) Sepsis 14 (7.1) 5.00 Renal disease 12 (6.1) 0.00 Pneumonia 9 (4.6) Chronic obstructive pulmonary disease 8 (4.1) Diabetes 7 (3.6) Gastric outlet obstruction 5 (2.5) Meningitis 5 (2.5) Gangrene 4 (2.0) Intestinal obstruction 4 (2.0) Types of cancer Severe malaria 4 (2.0) Alcohol intoxication 3 (1.5) Figure 1: Common types of cancers observed at admissions at Fractures 3 (1.5) Mbarara Regional Referral Hospital. Peritonitis 3 (1.5) Dysentry 2 (1.0) Gastroenteritis 2 (1.0) Metabolic encephalopathy 2 (1.0) 25.00 Oesophageal stricture 2 (1.0) 20.00 Others 27 (13.7) Total 197 (100) 15.00 10.00 5.00 Portugal, Brazil, and Italy [16–19] in a similar population but close to what was observed in Nigeria (18.7%) within a 0.00 related teaching hospital [20]. Again, our findings are the first to show such a high mortality in this population and require deeper investigations in future studies. We further investigated the most common health con- ditions that were observed among the patients that died during hospitalization. Stroke (15.2%), cancer (10.7%), head Types of cancer injury (8.1%), heart failure (7.1%), sepsis (7.1%), and renal disease (6.1%) accounted for the highest incidences. Indeed, Figure 2: Cancers associated with mortality among older adult population at Mbarara Regional Referral Hospital. the WHO predicts that by 2020, noncommunicable diseases such as heart disease, cancer, and diabetes will be among the main causes of mortality in the African region [21]. Already high incidences of cerebrovascular accident (25.1%) have (4.7%) among the most common causes of death in the been reported predominantly besides malignancies (15.2%), general population in Uganda [12]. (is is much different diabetes mellitus (8%), and congestive cardiac failure (6.2%) from what we observe in this study indicating that the two [20]. Others include septicemia (5.2%), trauma (4.6%), renal populations are completely unique. In addition, this adds failure and chronic obstructive pulmonary disease (3.9%). more evidence to support the need for more attention in this Currently, a joint extract from the WHO, World Bank, age group. and UNESCO, reports HIV/AIDS (13.3%), pneumonia According to the WHO, cancer is responsible for 365,000 (11%), diarrheal diseases (6.4%), malaria (4.8%), and stroke deaths annually [22]. Because of that, the study tried to Percentage Mortality rate Breast cancer Cervical cancer Cervical cancer Colon cancer Colon cancer Lung cancer Lung cancer Oesophagus cancer Oesophagus cancer Ovarian cancer Prostate cancer Prostate cancer Rectal cancer Cancer of rectum Skin cancer Stomach cancer Stomach cancer Liver cancer Others Journal of Aging Research 5 investigate the types of cancer. We observed that oeso- particularly thank Dr. Amir Abdallah for his constructive phageal cancer, lung cancer, and prostate cancer accounted comments in the initial stages of the study. (e study team, for the highest proportion. In the general public, the general especially Julian Nyakato, Justus Musiime, and Annette, national cancer mortality demographic data show that from MRRH is particularly acknowledged for the tireless among males, prostate cancer (25.1%) is the most common effort during data collection. Finally, special thanks to cause of mortality followed by oesophagus cancer (16.0%) MURTI for funding this work. Research reported in this and liver cancer at 8.2%, while in females, it is cervical cancer publication was supported by the Fogarty International (24.2%), breast cancer (12.5%), oesophageal cancer (7.7%), Center and co-funding partners (NIH Common Fund, and liver cancer (5.8%) [22]. Our findings differ slightly from Office of Strategic Coordination, and Office of the Director the national figure with oesophageal cancer being the most (OD/OSC/CF/NIH); Office of AIDS Research and Office of common cause of mortality. the Director (OAR/NIH); National Institute of Mental One of the limitations for this study is that some records Health (NIMH/NIH); and National Institute of Neurological did not provide sufficient demographic data. In addition, the Disorders and Stroke (NINDS/NIH)) of the National In- antecedent causes of death were not confirmed due to stitutes of Health under the award number D43TW010128. paucity of postmortem reports. Finally, other outcomes that could impact the health systems such as hospital costs and References readmission rate could not be explored. [1] C. V. Khole, A. Soletti, J. Mo et al., An Aging World: Inter- 6. Conclusion national Population Reports, Appetite, Amsterdam, Nether- lands, 2016. Our study has highlighted the major health challenges that [2] UNDP, Help Age A. Ageing, Older Persons and the 2030 cause older adults to be hospitalized in a regional referral Agenda for Sustainable Development, United Nations Publi- cations, New York, NY, USA, 2017. hospital population. In addition, the study has shown that [3] World Health Organization, Global Health Observatory Data there is poor prognosis in this age group and requires further Repository: Life Expectancy, World Health Organization, comprehensive investigations. Geneva, Switzerland, 2019. [4] W. He, D. Goodkind, and P. Kowal, An Aging World: 2015, Abbreviations International Population Reports, United States Census Bu- reau, Suitland, MA, USA, 2016. MRRH: Mbarara Regional Referral Hospital [5] United Nations PDD of E and SA, World Aging Population, WHO: World Health Organization United Nations New York, New York, NY, USA, 2017. UNESCO: United Nations Educational, Scientific, and [6] M. J. Prince, F. Wu, Y. Guo et al., “(e burden of disease in Cultural Organization. older people and implications for health policy and practice,” 5e Lancet, vol. 385, no. 9967, pp. 549–562, 2015. Data Availability [7] R. M. Palmer, ““Acute hospital care of the elderly: making a difference,” in caring for the hospitalized elderly: current best (e data used to support the findings of this study are practice and new horizons,” Society of Hospital Medicine, available from the corresponding author upon request. pp. 4–7, 2004. [8] P. Hendy, J. H. Patel, T. Kordbacheh, N. Laskar, and M. Harbord, “In-depth analysis of delays to patient discharge: Disclosure a metropolitan teaching hospital experience,” Clinical Med- (e content is solely the responsibility of the authors and icine, vol. 12, no. 4, pp. 320–323, 2012. [9] United Nations, World Population Ageing, 2013, United does not necessarily represent the official views of the Na- Nations, New York, NY, USA, 2014. tional Institutes of Health. [10] C. S. Landefeld, “Improving health care for older persons,” Annals of Internal Medicine, vol. 139, no. 5, p. 421, 2003. Conflicts of Interest [11] WHO, World Health Report on Aging and Health, WHO, Geneva, Switzerland, 2015. (e authors declare that there are no conflicts of interest [12] WHO, World Health Ranking: Health Profile: Uganda, WHO, regarding the publication of this paper. Geneva, Switzerland, 2017. [13] Y. Boum, D. Atwine, P. Orikiriza et al., “Male gender is in- Authors’ Contributions dependently associated with pulmonary tuberculosis among sputum and non-sputum producers people with presumptive PO and JB conceived the idea and designed the protocol. PO, tuberculosis in Southwestern Uganda,” BMC Infectious Dis- GZR, AK, and JB analyzed the data and wrote and reviewed eases, vol. 14, no. 1, 2014. the manuscript. All the authors approved the final version of [14] H. R. Wabinga, S. Nambooze, P. M. Amulen, C. Okello, the manuscript. L. Mbus, and D. M. Parkin, “Trends in the incidence of cancer in Kampala, Uganda 1991–2010,” International Journal of Cancer, vol. 135, no. 2, pp. 432–439, 2014. Acknowledgments [15] A. M. V. Staden and D. J. V. Weich, “Profile of the geriatric We express our gratitude and thanks to the administrators at patient hospitalised at Universitas Hospital, South Africa,” MRRH for allowing us to access patients’ records. We South African Family Practice, vol. 49, no. 2, pp. 14–14c, 2007. 6 Journal of Aging Research [16] T. Ayaz, S. B. Sahin, O. Z. Sahin, O. Bilir, and H. Rakici, “Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons,” Journal of Aging Research, vol. 2014, Article ID 584315, 7 pages, 2014. [17] S. Sousa, M. F. Moraes, V. Beato et al., “Predictive factors of hospital and 6-month morbidity and mortality in hospitalized elderly patients,” Acta Medica Portuguesa, vol. 15, no. 3, pp. 177–184, 2002. [18] T. J. A. Silva, C. S. Jerussalmy, J. M. Farfel, J. A. E. Curiati, and W. Jacob-Filho, “Predictors of in-hospital mortality among older patients,” Clinics, vol. 64, no. 7, pp. 613–618, 2009. [19] M. Ponzetto, B. Maero, P. Maina et al., “Risk factors for early and late mortality in hospitalized older patients: the con- tinuing importance of functional status,” 5e Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol. 58, no. 11, pp. M1049–M1054, 2011. [20] G. D. Forae and O. J. Uchendu, “Diseases mortality patterns in elderly patients: a Nigerian teaching hospital experience in Irrua, Nigeria,” Nigerian Medical Journal, vol. 54, no. 4, p. 250, [21] Nations U. Aging, Online Data, 2019. [22] WHO, Profile Cancer Mortality Trends Uganda, WHO, Ge- neva, Switzerland, 2014. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Aging Research Hindawi Publishing Corporation

Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional Referral Hospital in Southwestern Uganda

Loading next page...
 
/lp/hindawi-publishing-corporation/clinical-conditions-of-hospitalized-older-adult-patients-and-their-imCfZtdOQt
Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2020 Patrick Orikiriza et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2090-2204
eISSN
2090-2212
DOI
10.1155/2020/6830495
Publisher site
See Article on Publisher Site

Abstract

Hindawi Journal of Aging Research Volume 2020, Article ID 6830495, 6 pages https://doi.org/10.1155/2020/6830495 Research Article Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional Referral Hospital in Southwestern Uganda 1,2 3 4 1 Patrick Orikiriza , Godfrey Z. Rukundo , Adrian Kayanja, and Joel Bazira Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda Division of Basic Medical Sciences, University of Global Health Equity, Kigali, Rwanda Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda Correspondence should be addressed to Patrick Orikiriza; patrickorikiriza@gmail.com Received 16 January 2020; Accepted 8 June 2020; Published 29 June 2020 Academic Editor: F. R. Ferraro Copyright © 2020 Patrick Orikiriza et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Recent advances in medicine have caused positive impact on the life expectancy of most countries, resulting in increased older adult population. Aging comes with a number of health challenges. (is study investigated health conditions of older adults at admission and clinical outcomes in a regional referral hospital in southwestern Uganda. Methods. A retrospective study reviewed clinical data of older adult patients admitted between January 2016 and December 2017. Demographic data, cause of admission, length, and outcomes of hospitalization are described. Results. Up to 813 patient files were reviewed. (e patients had been hospitalized to emergency, 371 (45.6%); medical, 355 (43.7%); surgical, 84 (10.3%); psychiatry, 2 (0.3%); and obstetrics and gynecology, 1 (0.1%) wards. (e majority, 427 (52.5%), of the patients were females. Cancer was the most common reason for hospitalization, 130/889 (14.6%), followed by stroke, 94/889 (10.6%); heart failure, 76/889 (8.6%); chronic obstructive pulmonary disease, 56/889 (6.3%); pneumonia, 47/889 (5.3%); and head injury, 45/889 (5.1%), whilst 560 (68.9%) of the hospitalized patients were discharged, 197 (24.2%) died, 18 (2.2%) were referred for advanced care, and 38 (4.7%) escaped from the facility. (e emergency ward had the highest deaths, 101 (51.3%), then medical, 56 (28.4%), and surgical, 39 (19.8%), wards. Mortality of those who died was admitted with stroke, 30 (15.2%), cancer, 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), sepsis, 14 (7.1%), and renal disease, 12 (6.1%). On average, patients were admitted for 5 days (IQR: 3–8). Conclusions. (e high proportion of mortality in this group is worrying and requires further investigations. years. In line with this, the global population of older adult 1. Background people in 2017 was estimated to be 962 million people and Globally, aging populations are emerging at a rapid rate due projected to reach nearly 2.1 billion by 2050 [5], and the to the general increase in life expectancy following advance majority of whom (two-thirds) are in developing in medicine and improved health systems in most countries countries. [1]. (e United Nations Definition of Older Persons includes Old age comes with a number of medical and social individuals aged 60 years and more [2]. challenges that need appropriate and timely interventions In the 2016 WHO report, the global life expectancy [5] to allow active participation in societal development. was estimated at 72 years: 74.2 years for females and 69.8 Indeed, studies have shown that older adult people con- years for males [3]. An annual growth of 3% has been tribute to up to 23% of the total global burden of diseases [6]. noted among the older adult population [4], and many Also, more evidence particularly from developed countries countries are expected to witness a similar trend over the indicate that older adult people are hospitalized more 2 Journal of Aging Research frequently and for a longer period of time than any other age Patient records were maintained at the strictest level of groups as they tend to suffer more severe forms of diseases confidentiality by all members of the study team. On all data that are difficult to diagnose and treat [7, 8]. (is can be collection documents, patient identifiers such as names were highly challenging in low resource settings as it continuously concealed and replaced with unique study identification impacts on their psychological, social, economic abilities and numbers and these records were maintained in locked file that of the health system [9]. cabinets. Even in developed countries where health services are (e study was permitted by the MRRH administration much improved, challenges among older adult people are and approved by the Research Ethics Committee of the common. In one study, it has been reported that one-third of Mbarara University of Science and Technology (18/08-18) as hospitalized older adult patients face more complication by well as the Uganda National Council for Science and the time of discharged, including reduced functional ca- Technology (HS323ES). pacity, than at admission [10]. (e study further reveals that approximately 5% of these die during hospital stay and 20%– 3. Statistical Analysis 30% pass away within one year after hospital discharge. (is indicates that there is a much bigger hidden problem that A case report form comprising of patient demographic data needs to be urgently addressed in order to meet the WHO and clinical conditions was double entered into EpiData and call for the Universal Health Coverage. analyzed using STATA version 13 (Texas, USA). Descriptive Although the WHO attributes most of the health statistics were expressed as proportions in form of tables and problems of the older adults to chronic diseases [11], very graphs. few studies have investigated the specific type of conditions and extent of this burden in low resource countries. To properly address these concerns, it is important to study the 4. Results common conditions so as to establish specific interventions. Uganda is already experiencing an increase in the We reviewed a total of 813 files during the study period population of older adult people as a result of improved life between September and March 2019. Among those with expectancy to 62.5 years [12]. Indeed, in the 2017 WHO gender records, 427 (52.5%) were females and the median report, the older adult people constituted approximately age was 70 (IQR: 65–80). As shown in Table 1, most of the 1425000 (3.3%) of general population and this number is patients were married, 352 (43.3%), with no formal edu- expected to quadruple by 2050 [5]. Despite this increasing cation, 283 (34.8%), and admitted by self-referral, 634 (78%). trend, most health facilities lack dedicated services for this (e majority of patients were admitted to the emergency particular population. Indeed, there is limited evidence on ward, 371 (45.6%), and medical ward, 355 (43.7%). health conditions of hospitalized older adult patients in (e most common reasons for hospitalization were as Uganda. follows: cancer, 130 (14.5%), stroke, 94 (10.5%), heart failure, With accurate data on the profiles of older adult patients 76 (8.5%), chronic obstructive pulmonary disease, 56 (6.2%), and the common diseases that cause their hospital admis- pneumonia, 47 (5.2%), head injuries, 45 (5.0%), diabetes, 43 sions, policies can be enacted to adequately provide necessary (4.8%), hypertension, 36 (4.0%), sepsis, 35 (3.9%), severe human and infrastructural resources required to meet health anemia, 31 (3.4%), and severe malaria, 25 (2.8%), as shown needs of this age-group as emphasized in the holistic ap- in Table 2. proach of the global agenda for sustainable development [5]. While 560 (68.9%) of the hospitalized patients were (is study is among the fast to highlight the health plight discharged, 197 (24.2%) died, 18 (2.2%) were referred for of hospitalized older adult patients in a rural hospital in advanced care, and a large proportion, 38 (4.7%), escaped Uganda. (e study also described the outcomes and com- from the facility (Table 3). mon medical conditions that resulted in mortality among (e emergency ward had the highest deaths, 101 (51.3%), these patients. followed by medical, 56 (28.4%), and surgical, 39 (19.8%), wards (Table 4). Most of the patients died from stroke, 30 (15.2%), cancer, 2. Methods 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), We reviewed all medical records of older adult patients sepsis, 14 (7.1%), and renal disease, 12 (6.1%) (Table 5). As shown in Figure 1, cancer of the oesophagus was the admitted between January 2016 and December 2018, on medical, psychiatry, obstetrics and gynecology, surgical, and most common form of cancer at admission, 34/130 (26.2%), followed by stomach cancer, 20/130 (15.4%), and prostate emergency wards within Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Demographic data, cancer, 19/130 (14.6%). proportion of older adults, health reason, duration, and Most of the people who died from cancer were diagnosed outcomes of hospitalization were described from the rec- at admission with the majority presenting with esophageal ords. (is was an exploratory study, and therefore sample cancer, 5/21 (23.8%), lung cancer, 4/21 (19.1%), prostate size was not estimated. Instead, all the records within two cancer, 3/21 (14.3%), cervical cancer, 2/21 (9.5%), colon years were judged to give reasonable evidence. As a quality cancer, 2/21 (9.5%), stomach cancer, 2/21 (9.5%), and rectal, control, each file was reviewed by two study research as- ovary, and liver cancer, 1/21 (4.8%) each, in that order sistants and verified by the principal investigator. (Figure 2). Journal of Aging Research 3 Table 1: Demographic characteristics of older adult patients at Table 2: Clinical conditions of older adult patients at admission in MRRH. MRRH. Characteristics n (%), n � 813 Disease condition n (%) Age median (IQR) 70 (65–80) Cancer 130 (14.5) Stroke 94 (10.5) Gender Heart failure 76 (8.5) Male 386 (47.5) Chronic obstructive pulmonary disease 56 (6.2) Female 427 (52.5) Pneumonia 47 (5.2) Tribe Head injury 45 (5.0) Munyankole 517 (63.6) Diabetes 43 (4.8) Mukiga 43 (5.3) Hypertension 36 (4.0) Muganda 30 (3.7) Sepsis 35 (3.9) Others 9 (1.1) Severe anemia 31 (3.4) Not indicated 214 (26.3) Severe malaria 25 (2.8) Marital status Fractures 24 (2.7) Single 97 (11.9) Intestinal obstruction 19 (2.1) Married 352 (43.3) Renal disease 18 (2.0) Not indicated 364 (44.8) Hernia 13 (1.4) Level of education Gastric outlet obstruction 12 (1.3) None 283 (34.8) Tuberculosis 11 (1.2) Primary 22 (2.7) Electrolyte imbalance 10 (1.1) Secondary 5 (0.6) Upper gastrointestinal bleeding 10 (1.1) University/tertiary 25 (3.1) Meningitis 9 (1.0) Not indicated 478 (58.8) Liver disease 9 (1.0) Gangrene 8 (0.9) Type of admission Gastroenteritis 7 (0.7) Referral 179 (22.0) Self-referred 634 (78.0) Dementia 5 (0.5) Peritonitis 5 (0.5) Admission ward Alcohol intoxication 4 (0.4) Medical 355 (43.7) Oesophageal stricture 3 (0.3) Psychiatry 2 (0.3) Others 104 (11.7) Obs and gyn 1 (0.1) Total 889 (100) Surgical 84 (10.3) Emergency 371 (45.6) Table 3: Outcomes of older adult patients admitted at MRRH. Finally, an average time of 5 days (IQR: 3–8) of ad- mission was observed among this population. Outcome n (%) Patient was discharged 560 (68.9) Patient referred for advanced care 18 (2.2) 5. Discussion Patient escaped from facility 38 (4.7) Patient died 197 (24.2) (is study investigated the health conditions that caused Total 813 (100) older adult people to be admitted at a regional hospital in a semiurban community of southwestern Uganda. (e study highlights critical issues and eventual outcomes. According predominant causes of hospitalization [15]. Besides diabetes, to our knowledge, this is the first study to bring attention to the main cause for hospitalization in Europe, the other main the heath plight of this particular population. conditions include cardiovascular diseases and pulmonary First, we have shown that close to 1000 older adult people diseases, which are similar to what we observed in this study were hospitalized in this regional hospital within two years. [16]. Indeed, by grouping the health conditions observed, (e male to female ratio was also close to 1, which is similar to cardiovascular diseases such as stroke, heart failure, and what we observed in our previous tuberculosis study among hypertension together contributed up to 29.2% of disease adults aged 18 and above, in the same setting [13]. burden. Another study reported these cardiovascular diseases Secondly, our study has shown that cancer, stroke, heart (30.3%) as the leading contributors to disease burden in older failure, chronic obstructive disease, pneumonia, and head adult people followed by cancer (15.1%) and chronic respi- injury dominated as most common conditions causing ratory diseases (9·5%) [6]. Although different context, the hospitalization. (e raise in the number of cancer cases in the proportions are much similar, indicating that addressing country has been previously described in the general pop- these health challenges could greatly minimize overall risks of ulation [14]. (e rates reported in this study are in tandem hospitalization in many settings. with national figures [12]. Other countries have reported a In the outcome analysis, this study observed an in- different disease spectrum in a similar population. In one of hospital mortality rate of 24.2% while 68.9% were dis- the few African studies, hypertension, heart failure, ischemic charged. Our findings on mortality is much higher than heart disease, and anemia were reported as the most 8.5%, 12%, 16.4%, and 14.9% previously reported in Turkey, 4 Journal of Aging Research Table 4: In-patient outcomes according to the ward of admission. Hospital wards Outcome Medical Psychiatry Obs/gyn Surgical Emergency Total Discharged 276 2 0 40 242 560 Referred 10 0 0 1 7 18 Escaped 13 0 0 4 21 38 Died 56 0 1 39 101 197 Total 355 2 1 84 371 813 Table 5: Antecedent causes of death among older adult patients at 30.00 MRRH. 25.00 Diagnosis made Died, n (%) 20.00 Stroke 30 (15.2) Cancer 21 (10.7) 15.00 Head injury 16 (8.1) 10.00 Heart failure 14 (7.1) Sepsis 14 (7.1) 5.00 Renal disease 12 (6.1) 0.00 Pneumonia 9 (4.6) Chronic obstructive pulmonary disease 8 (4.1) Diabetes 7 (3.6) Gastric outlet obstruction 5 (2.5) Meningitis 5 (2.5) Gangrene 4 (2.0) Intestinal obstruction 4 (2.0) Types of cancer Severe malaria 4 (2.0) Alcohol intoxication 3 (1.5) Figure 1: Common types of cancers observed at admissions at Fractures 3 (1.5) Mbarara Regional Referral Hospital. Peritonitis 3 (1.5) Dysentry 2 (1.0) Gastroenteritis 2 (1.0) Metabolic encephalopathy 2 (1.0) 25.00 Oesophageal stricture 2 (1.0) 20.00 Others 27 (13.7) Total 197 (100) 15.00 10.00 5.00 Portugal, Brazil, and Italy [16–19] in a similar population but close to what was observed in Nigeria (18.7%) within a 0.00 related teaching hospital [20]. Again, our findings are the first to show such a high mortality in this population and require deeper investigations in future studies. We further investigated the most common health con- ditions that were observed among the patients that died during hospitalization. Stroke (15.2%), cancer (10.7%), head Types of cancer injury (8.1%), heart failure (7.1%), sepsis (7.1%), and renal disease (6.1%) accounted for the highest incidences. Indeed, Figure 2: Cancers associated with mortality among older adult population at Mbarara Regional Referral Hospital. the WHO predicts that by 2020, noncommunicable diseases such as heart disease, cancer, and diabetes will be among the main causes of mortality in the African region [21]. Already high incidences of cerebrovascular accident (25.1%) have (4.7%) among the most common causes of death in the been reported predominantly besides malignancies (15.2%), general population in Uganda [12]. (is is much different diabetes mellitus (8%), and congestive cardiac failure (6.2%) from what we observe in this study indicating that the two [20]. Others include septicemia (5.2%), trauma (4.6%), renal populations are completely unique. In addition, this adds failure and chronic obstructive pulmonary disease (3.9%). more evidence to support the need for more attention in this Currently, a joint extract from the WHO, World Bank, age group. and UNESCO, reports HIV/AIDS (13.3%), pneumonia According to the WHO, cancer is responsible for 365,000 (11%), diarrheal diseases (6.4%), malaria (4.8%), and stroke deaths annually [22]. Because of that, the study tried to Percentage Mortality rate Breast cancer Cervical cancer Cervical cancer Colon cancer Colon cancer Lung cancer Lung cancer Oesophagus cancer Oesophagus cancer Ovarian cancer Prostate cancer Prostate cancer Rectal cancer Cancer of rectum Skin cancer Stomach cancer Stomach cancer Liver cancer Others Journal of Aging Research 5 investigate the types of cancer. We observed that oeso- particularly thank Dr. Amir Abdallah for his constructive phageal cancer, lung cancer, and prostate cancer accounted comments in the initial stages of the study. (e study team, for the highest proportion. In the general public, the general especially Julian Nyakato, Justus Musiime, and Annette, national cancer mortality demographic data show that from MRRH is particularly acknowledged for the tireless among males, prostate cancer (25.1%) is the most common effort during data collection. Finally, special thanks to cause of mortality followed by oesophagus cancer (16.0%) MURTI for funding this work. Research reported in this and liver cancer at 8.2%, while in females, it is cervical cancer publication was supported by the Fogarty International (24.2%), breast cancer (12.5%), oesophageal cancer (7.7%), Center and co-funding partners (NIH Common Fund, and liver cancer (5.8%) [22]. Our findings differ slightly from Office of Strategic Coordination, and Office of the Director the national figure with oesophageal cancer being the most (OD/OSC/CF/NIH); Office of AIDS Research and Office of common cause of mortality. the Director (OAR/NIH); National Institute of Mental One of the limitations for this study is that some records Health (NIMH/NIH); and National Institute of Neurological did not provide sufficient demographic data. In addition, the Disorders and Stroke (NINDS/NIH)) of the National In- antecedent causes of death were not confirmed due to stitutes of Health under the award number D43TW010128. paucity of postmortem reports. Finally, other outcomes that could impact the health systems such as hospital costs and References readmission rate could not be explored. [1] C. V. Khole, A. Soletti, J. Mo et al., An Aging World: Inter- 6. Conclusion national Population Reports, Appetite, Amsterdam, Nether- lands, 2016. Our study has highlighted the major health challenges that [2] UNDP, Help Age A. Ageing, Older Persons and the 2030 cause older adults to be hospitalized in a regional referral Agenda for Sustainable Development, United Nations Publi- cations, New York, NY, USA, 2017. hospital population. In addition, the study has shown that [3] World Health Organization, Global Health Observatory Data there is poor prognosis in this age group and requires further Repository: Life Expectancy, World Health Organization, comprehensive investigations. Geneva, Switzerland, 2019. [4] W. He, D. Goodkind, and P. Kowal, An Aging World: 2015, Abbreviations International Population Reports, United States Census Bu- reau, Suitland, MA, USA, 2016. MRRH: Mbarara Regional Referral Hospital [5] United Nations PDD of E and SA, World Aging Population, WHO: World Health Organization United Nations New York, New York, NY, USA, 2017. UNESCO: United Nations Educational, Scientific, and [6] M. J. Prince, F. Wu, Y. Guo et al., “(e burden of disease in Cultural Organization. older people and implications for health policy and practice,” 5e Lancet, vol. 385, no. 9967, pp. 549–562, 2015. Data Availability [7] R. M. Palmer, ““Acute hospital care of the elderly: making a difference,” in caring for the hospitalized elderly: current best (e data used to support the findings of this study are practice and new horizons,” Society of Hospital Medicine, available from the corresponding author upon request. pp. 4–7, 2004. [8] P. Hendy, J. H. Patel, T. Kordbacheh, N. Laskar, and M. Harbord, “In-depth analysis of delays to patient discharge: Disclosure a metropolitan teaching hospital experience,” Clinical Med- (e content is solely the responsibility of the authors and icine, vol. 12, no. 4, pp. 320–323, 2012. [9] United Nations, World Population Ageing, 2013, United does not necessarily represent the official views of the Na- Nations, New York, NY, USA, 2014. tional Institutes of Health. [10] C. S. Landefeld, “Improving health care for older persons,” Annals of Internal Medicine, vol. 139, no. 5, p. 421, 2003. Conflicts of Interest [11] WHO, World Health Report on Aging and Health, WHO, Geneva, Switzerland, 2015. (e authors declare that there are no conflicts of interest [12] WHO, World Health Ranking: Health Profile: Uganda, WHO, regarding the publication of this paper. Geneva, Switzerland, 2017. [13] Y. Boum, D. Atwine, P. Orikiriza et al., “Male gender is in- Authors’ Contributions dependently associated with pulmonary tuberculosis among sputum and non-sputum producers people with presumptive PO and JB conceived the idea and designed the protocol. PO, tuberculosis in Southwestern Uganda,” BMC Infectious Dis- GZR, AK, and JB analyzed the data and wrote and reviewed eases, vol. 14, no. 1, 2014. the manuscript. All the authors approved the final version of [14] H. R. Wabinga, S. Nambooze, P. M. Amulen, C. Okello, the manuscript. L. Mbus, and D. M. Parkin, “Trends in the incidence of cancer in Kampala, Uganda 1991–2010,” International Journal of Cancer, vol. 135, no. 2, pp. 432–439, 2014. Acknowledgments [15] A. M. V. Staden and D. J. V. Weich, “Profile of the geriatric We express our gratitude and thanks to the administrators at patient hospitalised at Universitas Hospital, South Africa,” MRRH for allowing us to access patients’ records. We South African Family Practice, vol. 49, no. 2, pp. 14–14c, 2007. 6 Journal of Aging Research [16] T. Ayaz, S. B. Sahin, O. Z. Sahin, O. Bilir, and H. Rakici, “Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons,” Journal of Aging Research, vol. 2014, Article ID 584315, 7 pages, 2014. [17] S. Sousa, M. F. Moraes, V. Beato et al., “Predictive factors of hospital and 6-month morbidity and mortality in hospitalized elderly patients,” Acta Medica Portuguesa, vol. 15, no. 3, pp. 177–184, 2002. [18] T. J. A. Silva, C. S. Jerussalmy, J. M. Farfel, J. A. E. Curiati, and W. Jacob-Filho, “Predictors of in-hospital mortality among older patients,” Clinics, vol. 64, no. 7, pp. 613–618, 2009. [19] M. Ponzetto, B. Maero, P. Maina et al., “Risk factors for early and late mortality in hospitalized older patients: the con- tinuing importance of functional status,” 5e Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol. 58, no. 11, pp. M1049–M1054, 2011. [20] G. D. Forae and O. J. Uchendu, “Diseases mortality patterns in elderly patients: a Nigerian teaching hospital experience in Irrua, Nigeria,” Nigerian Medical Journal, vol. 54, no. 4, p. 250, [21] Nations U. Aging, Online Data, 2019. [22] WHO, Profile Cancer Mortality Trends Uganda, WHO, Ge- neva, Switzerland, 2014.

Journal

Journal of Aging ResearchHindawi Publishing Corporation

Published: Jun 29, 2020

References