Risk factors associated with Hospital complications in elderly patients to Hospital Nacional Edgardo Rebagliati Martins Lima, 2010
DOI:
https://doi.org/10.24265/horizmed.2015.v15n1.06Keywords:
Injuries, Injuries by domestic violence, Forensic examinationAbstract
Objective: The prolongation of life expectancy; the prevalence of chronic diseases; the physiological changes that occur in aging; deterioration in functional status; and frequent use of hospital services; expose older adults to hospital complications. We want to identify the main risk factors associated with hospital complications in older adults in Edgardo Rebagliati Martins National Hospital, Lima. Material and Methods: A matched case controls study (2: 1) was designed; Cases: older adults with hospital complications, registered in the system of active surveillance, defined criteria of the Center for Disease Control (CDC); during November 2010 to February 2011 and as controls: seniors, no hospital complications recorded at the hospital management system. A structured questionnaire that included factors prior comorbidity (Charlson index) and baseline functional status and functional loss during hospitalization (Barthel) was applied; and frequently chord definitions of the Center for Disease Control hospital complications. Results: 228 older adults (76 cases and 152 controls) .The main risk factors associated found in multiple logistic regression model were cancer (OR: 44.45 CI 12.5 to 175.10), chronic obstructive pulmonary disease (OR: 9.51, CI 3.10 to 29.16), peripheral arterial disease (OR: 7.57, CI: 2.24 to 25.58), diabetes (OR = 5.1886; IC : 12.5 to 157.10), heart failure (OR: 4.5931 CI: 1.2971 to 16.26), impaired baseline functional status (OR: 10.20; CI: 2,31 to 44.93) and total burden of comorbidity (OR: 17.08; CI 1.52 to 191.70). The other factors (dementia, chronic renal failure, cerebrovascular disease and functional decline during hospitalization), had no statistical significance. Conclusion: Cancer, COPD, peripheral arterial disease, diabetes, heart failure, impaired baseline functional status; and overall burden of comorbidity are the main risk factors associated with hospital complications in older adults.
Downloads
References
Gamarra P, Villarán R. Estudio epidemiológico de los pacientes mayores de 60 años hospitalizados en el Hospital Edgardo Rebagliati Martins en 1990. Trabajo presentado en el III Congreso de Geriatría y Gerontología (Nov 1992).
Becker PM, McVey LJ, Saltz CC, Feussner JR, Cohen HJ. (1987) Hospital-acquiredcomplications in a randomized controlled clinical trial of a geriatric consultation team. JAMA. 1987 May 1; 257(17):2313-7. PubMed PMID: 3553627.
Pita S, Pertezas S. Investigación cuantitativa y cualitativa. CAD Atención Primaria. 2002;9:76.
Baztán JJ, Fernández-Alonso M, Aguado R, Socorro A. Resultados al año de la rehabilitación tras fractura de fémur proximal en mayores de 84 años. An Med Interna 2004; 21:433-40.
Sarbatés O, Miralles R, Ferre M, Esperanza A, García-Palleiro P, Llorach I, et al. Factores predictivos de retorno al domicilio en pacientes ancianos hospitalizados. An Med Interna 1999;16:407-14.
Gutiérrez-Rodríguez J, Galeano-Arboleya R, Alonso-Álvarez M, Varela-Suárez C, Solano-Jaurrieta JJ.¿Es útil el índice de Barthel en la detección de riesgo de deterioro funcional en pacientes ancianos ingresados por enfermedad aguda? Rev Mult Gerontol J 1998; 8:213-9.
Baztán JJ, González M, Morales C, Vázquez E, Morón N, Forcano S, et al. Variables asociadas a la recuperación funcional y la institucionalización al alta en ancianos ingresados en una unidad geriátrica de media estancia. Rev Clín Esp 2004; 204:574-82.
Guillén Llera F, Pérez del Molino J. Manual de Geriatría Sindromes y Cuidados en el paciente Geriátrico. Madrid. Editorial Masson. 1996.
Gamarra P. Consecuencias de la Hospitalización en el Anciano. Rev Soc Peru Med Inter. 2001;14(2):90-8.
Russo, P.L.Spelman, D.W. A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2002;23:372-376.
Vilar-Compte D, Sandoval S, Gordillo P, et al. Surveillance of surgical wound infections. 18-month experience in the Instituto Nacional de Cancerología. Salud Pública Mex 1999; 41 Supl 1:S44- 50.
Abdel-Fattah MM. Nosocomial pneumonia: risk factors, rates and trends. East Mediterr Health J. May-Jun 2008; 14(3):546-55. PubMed PMID: 18720618.
Fakih MG, Sharma M, Khatib R, Berriel-Cass D, Meisner S, Harrington S, Saravolatz L. Increase in the rate of sternal surgical site infection after coronary artery bypass graft: a marker of higher severity of illness. Infect Control Hosp Epidemiol 2007;14:655-660. doi: 10.1086/518347.
El Solh, A., Bhora, M., Pineda, L., & Dhillon, R. Nosocomial pneumonia in elderly patients following cardiac surgery. Respiratory Medicine 2006; 100(4), 729-736.
Cheng, H., & Wang, L. Intestinal parasites may not cause nosocomial infections in psychiatric hospitals. Parasitology Research 2005; 95(5), 358-362. Retrieved from EBSCOhost.
Cheng, V., Wu, A., Cheung, C., Lau, S., Woo P., Chan, K., & ... Yuen, K. Outbreak of human metapneumovirus infection in psychiatric inpatients: implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks. The Journal Of Hospital Infection 2007; 67(4), 336-343. Retrieved from EBSCOhost.
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural of the systemic inflamatory response syndrome (SIRS). JAMA 1995; 273: 117-123.
Flores M. Factores de riesgo asociados a complicaciones post- quirúrgicas en pacientes mayores de 60 años con abdomen agudo en el Hospital Hipólito Unanue de Tacna 2003 - 2007.Tesis para optar título de especialista en geriatría. 2007.
Fariñas Alvarez, Fariñas, MC.; Llorca Díaz, J; Delgado Rodríguez, M. Factores de riesgo de sepsis nosocomial: un estudio de casos y controles Santander. Medicina clínica 2001; Vol 116(20).
Chrissoheris; Libertin C; RG Ali; Ghantous A; Bekui A, T Donohue. New Complicaciones nosocomilaes en la Sección de Cardiología del Hospital de Saint Raphael. 2009.
Chávez J. Estudio comparativo del abdomen agudo entre menores y mayores de 60 años. Universidad Particular Cayetano Heredia. Tesis para optar el título de médico cirujano. Lima 2000.
Ferreira Ka, Kimura M, Teixeira Mj, Mendoza Tr, Da Nóbrega Jcm, Graziani Sr, Takagaki Ty. Impact of cancer-related symptom synergisms on health-related quality of life and performance status. J Pain Symptom Manage 2008; 35: 604-16.
Fascia, D., Singanayagam, A., & Keating, J. Methicillin-resistant Staphylococcus aureus in orthopaedic trauma: identification of risk factors as a strategy for control of infection. The Journal of Bone And Joint Surgery 2009. British Volume, 91(2), 249-252. Retrieved from EBSCOhost.
Bouza E, Pintado V, Rivera S, Blázquez R, Muñoz P, Cercenado E, Loza E, Rodríguez-Créixems M, Moreno S; Spanish Pneumococcal Infection Study Network (G03/103). Nosocomial bloodstream infections caused by Streptococcus pneumoniae. Clin Microbiol Infect.2005 Nov; 11(11):919-24. PubMed PMID: 16216109.
Rubins, J., Cheung, S., Carson, P., Rubins, H., & Janoff, E. Identification of clinical risk factors for nosocomial pneumococcal bacteremia. Clinical Infectious Diseases: An Official Publication of The Infectious Diseases Society Of America 1999, 29(1), 178-183. Retrieved from EBSCOhost.
Keles H, Ekici A, Ekici M, Bulcun E, Altinkaya V. Effect of chronic diseases and associated psychological distress on health-related quality of life. Intern Med J 2007; 6-11.
Abizanda Soler P, León, Ortiz M, Romero Rizos L, Sánchez Jurado PM, Luengo Márquez C, Domínnguez Martín L, et al. La pérdida funcional al ingreso, principal variable explicativa de discapacidad y mortalidad al alta y al mes en ancianos hospitalizados.Rev Esp Geriatr Gerontol 2007; 42: 201-11.
Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51(4):451-8. PubMed PMID: 12657063.
Margitic SE, Inouye SK, Thomas JL, Cassel CK, Regenstreif DI, Kowal J. Hospital outcomes project for the elderly (HOPE). Rationale and design for a prospective pooled analysis. J Am Geriatr Soc 1993; 41:258-67.
Kleinpell R; Fletcher K; Jennings B. Reducing Functional Decline in Hospitalized Elderly. Patient Safety and Quality: An Evidence- Based Handbook for Nurses. Chapter 11. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.
Mañas MD, Marchán E, Conde C, Sánchez S, Sánchez-Maroto T, Molina MC. Deterioro de la capacidad funcional en pacientes ancianos ingresados en un servicio de Medicina Interna. An Med Interna (Madrid) 2005; 22: 130-2.
Alarcón T, Bárcena A, González-Montalvo JI, Penalosa C, Salgado A. Factors predictive of outcome on admission to an acute geriatric ward. Age Ageing. 1999 Sep; 28(5):429-32. PubMed PMID: 10529035.
Isaia G1, Bo M, Aimonino N, et al. Functional decline two weeks before hospitalization in an elderly population. Aging Clin Exp Res. 2010; 22(4):352-5.
Mudge, Alison M; Kasper, Karen; AU - Clair, Anne et al. Recurrent readmissions in medical patients: A prospective study. Journal of Hospital Medicine 2011; Volume 6, Issue 2:61-67.
Lamont CT, Sampson S, Matthias R, Kane R. The outcome of hospitalization for acute illness in the elderly. Journal of the American Geriatrics Society 1983, 31(5):282-288.
Foucault M. O. Nascimento da clínica. Rio de Janeiro: Forense Universitária. 1980.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 Horizonte Médico (Lima)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).
