Hospitalisation of adults with Down syndrome: lesson from a 10‐year experience from a community hospital

Abstract

Background Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co‐morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co‐morbidities and pattern of hospitalisation in adult patients with DS during a 10‐year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years. Method We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10‐year period and compared with those of the general adult population during the same time. Co‐morbidities were also described. Results Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co‐morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%. Conclusions Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co‐morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co‐morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.

Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study

“…However, men had fewer visits to outpatient health care visit and fewer planned visits than women. This result is not consistent with the few previous studies that have reported differences between men and women with DS using health care such as one study that report longer stay in hospitals for men compared with women with DS [ 19 , 28 ] and slightly more hospital admissions [ 28 ]. However, the previous studies included people at younger ages and no outpatient data.…”

“…with women with DS [19,28] and slightly more hospital admissions [28]. However, the previous studies included people at younger ages and no outpatient data.…”

“…During the last decade, a few studies have focused on gender differences in people with DS with respect to morbidity [18], health care utilisation [19] and mortality [9]. Gender differences have been reported for epilepsy as a comorbid condition with dementia, being more prevalent in women with DS than in men with DS [18].…”

“…This risk is even higher among women with DS as gonadal dysfunction, low hormone levels and early onset of menopause is more prevalent [21,22]. Regarding hospitalisation, men with DS have been reported to have longer inpatient stays than women with DS [19]. The gender differences in disease pattern and health care utilisation motivate the development of gender-specific health surveillance for older people with DS.…”

Immune Dysregulation and the Increased Risk of Complications and Mortality Following Respiratory Tract Infections in Adults With Down Syndrome

“…However, studies have only recently begun to focus on the adult DS population with respect to their rate of infections, and the number and length of hospitalizations. In general, hospitalization rate is higher in adults with DS compared with the general population due to pneumonia or aspiration (60)(61)(62). Tenenbaum and colleagues analyzed 297 hospitalizations of 120 adults with DS (aged 18-73 years in medical centers in Israel between 1988-2007) and compared these data with a control population.…”