Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines

Abstract

In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i) to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii) to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity), and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a) a literature review, (b) a register study, based on a unique population-based register The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

Frailty Is Independently Associated With Short-Term Outcomes for Elderly Patients With Non–ST-Segment Elevation Myocardial Infarction

“…The most common diagnostic category for this patient group is cardiovascular disease. [1][2][3] A recent scientific statement from the American Heart Association Council emphasized that the evaluation of frailty, comorbidity, and functional status is crucial when elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) are treated. 4 …”

Can We Get Better Value for Money in Long-term Care?

“…Structuring guidelines for the elderly population can be challenging, as they often need to address complex co-morbidities, and studies on younger populations without multi-morbidity may have limited generalisation value for older populations. Nevertheless, by encouraging standardisation among providers, the benefits to patients may be optimised (Ekerstad et al, 2008;Boyd, 2005). psychosocial support may also be included (Sargent et al, 2007;Challis et al, 2010).…”

The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration

“…As a consequence, frail old people are common in hospital-and they are also costly. In Sweden, for the patient group defined as 75 years or older, with >2 different diagnoses and >2 in-hospital stays during the last year, the costs comprise 19% of all national in-patient costs (6).…”