Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Abstract

BackgroundThe burden of neurological disorders (NDs) in older adult inpatients is often underestimated. We studied diagnostic frequency and comorbidity of NDs among inpatients aged ≥60 years. We compared rates of hospital mortality, length of stay (LOS), and readmission with younger patient counterparts (aged 18–59 years) and older adult non-neurological patients.MethodsThis was a retrospective cross-sectional study of inpatients in a tertiary care center in Brazil. We compiled data for all patients admitted between 1 January 2009 and 31 December 2010, and selected those aged ≥18 years for inclusion in the study. We collected data for inpatients under care of a clinical neurologist who were discharged with primary diagnoses of NDs or underlying acute clinical disorders, and data for complications in clinical or surgical inpatients. Patients who remained hospitalized for more than 9 days were categorized as having long LOS.ResultsOlder adult inpatients with NDs (n = 798) represented 56% of all neurological inpatients aged ≥18 years (n = 1430), and 14% of all geriatric inpatients (n = 5587). The mean age of older adult inpatients was 75 ± 9.1 years. Women represented 55% of participants. The most common NDs were cerebrovascular diseases (51%), although multimorbidity was observed. Hospital mortality rate was 18% (95% confidence interval [CI], 15–21) and readmission rate was 31% (95% CI, 28–35), with 40% of patients readmitted 1.8 ± 1.5 times. The long LOS rate was 51% and the median LOS was 9 days (interquartile interval, 1–20 days). In younger inpatients mortality rate was 1.4%, readmission rate was 34%, and long LOS rate was 14%. In older adult non-neurological inpatients, mortality rate was 22%, readmission rate was 49%, and long LOS rate was 30%.ConclusionsOlder adult neurological inpatients had the highest long LOS rate of all patient groups, and a higher mortality rate than neurological patients aged 18–59 years. Readmissions were high in all groups studied, particularly among older adult non-neurological inpatients. Improved structures and concerted efforts are required in hospitals in Brazil to reduce burden of NDs in older adult patients.

Predictors of readmission and long length of stay in elders admitted with neurological disorders in a tertiary center: a real-world investigation

“…In Brazil, the elderly population is increasing much faster than in developed countries, exceeding 30 million persons aged 60 years or older in 2017 14 . In a previously published study we found high rates of hospital readmission (31%), and long LOS (51%) during a two-year analysis of 798 elders hospitalized with NDs 15 . The present study intended to analyze demographic factors, NDs, and comorbidities in the population of elderly inpatients to identify independent predictors of readmission and long LOS.…”

“…The Information Technology Department at this hospital (IT-HSR) recorded all admissions during the period of the study. Further information regarding the HSR and the method for capturing patients, including details concerning ND diagnostic assessments, can be found in our previously-published studies of the same population 15,16 . We enrolled elderly inpatients with NDs in this study using the following methods: 1) IT-HSR searches of NDs listed in discharge summaries and 2) IT-HSR identification of registered neurological procedures.…”

Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

“…The Information Technology Department at this hospital (IT-HSR) searches billing codes in order to send invoices of the medical procedures to health sponsors and for paying physicians. Further information regarding the HSR and the method for capturing patients, including details regarding ND diagnostic assessments, can be found in our previously published study of the same population [ 20 ].…”

“…Furthermore, patients who suffer from NDs such as cerebrovascular disorders, Parkinson’s disease, dementia, muscular dystrophy, amyotrophic lateral sclerosis, myasthenia gravis and chronic polyneuropathies, usually die in hospital [ 17 - 19 ]. A two-year hospital mortality incidence of 18% (95% CI, 15%-21%) was found in elderly inpatients with NDs admitted to a tertiary medical center in Salvador, Brazil [ 20 ]. Predictors of hospital mortality studies covering total NDs are scarce, since previous studies have usually focused on single conditions.…”

Disease burden from COVID-19 symptoms among inpatients at the temporary military hospitals in Wuhan: a retrospective multicentre cross–sectional study

“… 12 Zhang et al 13 evaluated the BOD and related factors in hospitalised patients with coal workers’ pneumoconiosis and provided the basis for improving relevant medical policies. Bacellar et al 14 assessed BOD in hospitalised elderly patients with neurological disorders in Brazil and recommended measures to improve the treatment plan. Adopting the WHO approach, Pei et al 15 formulated the disability weights (DWs) for chronic mountain disease, which was used to calculate the BOD among soldiers stationed in Tibet and helped evaluate the ability of troops to perform tasks.…”