Abstract
ABSTRACTOBJECTIVE Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization.METHODS A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bagé, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (≥ 2 and ≥ 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables.RESULTS The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8–19.6) and 10.6% (95%CI 9.1–12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition’ form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09–2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan.CONCLUSIONS The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases.
Highlights
Hospitalization is an important resource in older adults care, and it is part of the health care network
Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09–2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan
Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases
Summary
Hospitalization is an important resource in older adults care, and it is part of the health care network. Hospitalizations, especially if repeated and prolonged, may produce negative consequences to older patients’ health, such as decreased functional disability, lower quality of life and increased fragility[6,7]. Older adults hospitalization should be indicated only when all other actions and services for the proper management of health problems have been exhausted. Health needs, mainly those expressed by chronic diseases, are one of the main determinants of elderly hospitalization[16]. With the rapid increase – absolute and relative – of the aging population, the prevalence of older adults with multiple chronic problems has reached 60%11. There is a growing interest in elderly multidimensional assessment and in the implications triggered by multimorbidity for the organization and offer of health actions and services[20,26]
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