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.
Highlights
The burden of neurological disorders (NDs) in older adult inpatients is often underestimated
Patient demographics In total, 1430 inpatients aged ≥18 years who met our selection criteria were admitted to Hospital Sao Rafael (HSR) with NDs during the study period
243 (30%) patients were admitted with clinical complications of underlying chronic NDs requiring neurological care, or were clinical or surgical patients with neurological complications
Summary
The burden of neurological disorders (NDs) in older adult inpatients is often underestimated. Chronic noncommunicable brain diseases, such as neurodegenerative disorders and stroke are among the leading causes of years of healthy life lost owing to disability [8]. Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain injury are neurological and neurosurgical disorders associated with in-hospital mortality. These disorders account for the highest premature mortality, a public health concern that can be quantified as years of potential life lost [9]. Health systems are generally configured for individual diseases rather than multimorbidity This is not appropriate for older adult patients with NDs, who have a high prevalence of multimorbidity; for patients who are economically disadvantaged [13, 14]. It is well known that stroke and neurological critical care units save lives and can reduce the length of hospital stay, many people with NDs admitted to hospital as emergency cases do not see a neurologist, even in developed countries [17,18,19,20]
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