THE MORBIDITY PATTERN OF GERIATRIC AGE GROUP PATIENTS ADMITTED IN MEDICINE WARD THROUGH EMERGENCY

Objectives: Geriatric patients have higher admission rates, readmission rates, mortality rates, and emergency department attendance rates as compared to younger patients. They suffer from multiple comorbidities. Hence, the current study aims to find out the common causes of emergency hospital admission of geriatric populations and to describe their morbidity pattern. Methods: A total of 208 geriatric patients were included in the study. After taking proper consent from the caregiver/relative; the detailed history of the patient had been taken, along with clinical examination had been done at bedside. Then relevant laboratory investigation (Biochemical, Pathological and Radiological) had performed. Statistical analysis was done according to the study parameter. Results: System-wise morbidities did not vary statistically among the participants of different age groups. Among the elderly population (>80 years) endocrinal morbidities (93.9%) followed by gastrointestinal morbidities were the most common (91.8%). On the other hand, among the relatively younger age group, that is, 60–70 years psychiatric morbidities were least common (18.3%). Among the morbidities noted, central nervous system (CNS) morbidities had a female preponderance, which was statistically significant. All the participants who were smokers were diagnosed with endocrinal morbidities. While among non-smokers 83.7% had endocrinal morbidities. The difference was statistically significant (p<0.001). All the participants who were chronic alcoholics were diagnosed with GI morbidities. While among non-alcoholics 81.9% had Endocrinal morbidities. The difference was statistically significant. Conclusion: The elderly persons have significantly higher admission rates, mortality rates, and ICU admission rates. Social, economic, and healthcare support for the elderly people can be effective in reducing morbidities and unwanted clinical outcomes.


INTRODUCTION
Geriatric health and diseases are influenced by the process of aging.Age is a recognized constitutional risk factor for many medical conditions, especially non-communicable diseases.Older patients are likely to have multiple comorbidities or chronic illnesses with impaired physical and cognitive function and are likely to have lesser social support.Geriatric patients are therefore at a higher risk of morbidity and mortality when they present with emergencies.This poses a management challenge to the emergency department (ED) physicians.As the number of people over the age of 65 years is increasing in both the developed and developing countries, the number of ED visits is also bound to increase [1][2][3].
Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia.Moreover, due to increasing age, they are more likely to experience several conditions at the same time.There is a rapid expansion of the geriatric age group due to increased longevity and so morbidities among them.Older age is also characterized by the initiation of several complex health states that mainly occur only later in life and that do not fall into discrete disease categories and these are commonly called geriatric syndromes [4][5][6].
As per 2001 statistics, around 75% of the elderly Indian population was residing in rural areas; approximately 73% of them were illiterate and involved in physical labor for their livelihood.The healthcare problems of the elderly are complicated as they suffer from both communicable as well as non-communicable diseases.Older patients have higher admission rates, readmission rates, mortality rates, and ED attendance rates as compared to younger patients.The susceptibility to infections increases with ageing.In addition, they suffer from multiple comorbidities.As a consequence, the morbidity and mortality of these infections increases in the geriatric population [7][8][9].
The current study aims to find out the most common causes of emergency hospital admission of geriatric patients and to describe their morbidity profile.

METHODS
This hospital-based cross-sectional observational descriptive epidemiological study was conducted in the indoor patient department of general medicine of Burdwan Medical College and Hospital in Purba Bardhaman District (West Bengal) for 18 months.The patients aged 60 years or above admitted in indoor department of general medicine through emergency; for the first time, were included for this study.Patients who died within 24 h of admission and did not give consent for participation were excluded from the study.

Procedure
The study was conducted after obtaining clearance from the Institutional Ethics Committee and Scientific Advisory Committee, Burdwan Medical College and Hospital, and then the approval for the proposed research was obtained from the West Bengal University of Health Sciences.The geriatric patients (i.e.aged >60 years), who were admitted through emergency due to some serious illness in the indoor medicine department, were identified first.Patients who did not survive after initial management and resuscitative measures within 24 h of admission; were excluded from the study population.Those patients survived after 24 h were selected for this observational study.After taking proper consent from the caregiver/relative; the detailed history of the patient had been taken along with a clinical examination had been done at bedside.Then relevant laboratory investigation (Biochemical, Pathological and Radiological) had performed.

Statistical analysis
Data (from questionnaire and schedule) were entered into a spreadsheet class/section, roll no wise, and exported to Statistical Package for the Social Sciences ® (SPSS) version 21.0 software for analysis.Descriptive statistics were used to describe the sociodemographic characteristics and etiologic and morbidity profile of the participants.Chi-squared tests were done to determine the difference between the observed proportions of etiologies and morbidities among different age groups, genders, and addiction habits.All tests were two-tailed, and p<0.05 was considered significant.

RESULTS
In the present study, the majority of the participants belonged to the age group 60-70 years, followed by 71-80 years and more than 80 years.49.5% of the participants were male and 50.5% were female.Overall, the majority of the participants (81.7%) belonged to Hinduism and 18.3% belonged to Islam.The majority of the participants (64.9%) were from urban area and 35.1% from rural.About 41.8% were illiterate, and 36.5% had educational level till primary.Overall, 37.5% belonged to lower middle, 26.0% to the upper middle, and 25.0% to poor socioeconomic class.The majority of the participants (70.7%) had no smoking habit and 29.3% had smoking habit.The majority of the participants (82.2%) had no chronic alcoholism history and 17.8% had chronic alcoholism history (Table 1).
The clinical profile of the participants revealed that 48.6% of the participants were conscious, 28.8% were drowsy and 22.6% unconscious.About 30.3% had pallor, 7.2% had cyanosis, 4.3% had jaundice, 9.1% had clubbing, 15.4% had edema.Overall, 59.6% of the participants were normal weight, 35.6% were overweight and 4.8% were obese.
Etiological profile showed that 10.6% of the participants had CVDs.About 90.9% of the participants with CVD had acute coronary syndrome and 9.1% had cardiomyopathy and heart failure.Participants with neurological diseases comprised 17.8%, of which 59.5% had ischemic cerebrovascular accident (CVA), 29.7% had hemorrhagic CVA and 10.8% had meningitis.Among the participants with respiratory diseases, 73.7% had chronic obstructive pulmonary disease (COPD) and respiratory failure; 21.0% had pulmonary TB and 5.3% had CA lung.Participants with genitourinary diseases comprises 10.1%; of which 81.0% of the had chronic kidney disease (CKD) and 19.0% had urinary tract infection (UTI) and pyelonephritis.Participants with gastrointestinal (GI) diseases comprises 9.1%; among them 63.2% had CLD and 21.0% had intestinal TB and 15.8% had GI malignancy.Among the participants with endocrinal diseases, 52.9% had hyperglycemia and 47.1% had hypoglycemia.Participants with psychiatric diseases comprise 4.3%; among them 88.9% had attempted suicide and 11.1% had other complications (Table 2).

DISCUSSION
In the present study, the majority (38.9%) of the participants belonged to the age group 60-70 years, followed by 71-80 years and more than 80 years.Barman [16] revealed that among study participants 59.5% were male and 40.5% were female in their study.In the present study, it was observed that 29.3% had smoking habit and 17.8% had chronic alcoholism history.
Vasanth et al. (2018) [17] stated that in their study 14% of patients had a history of active alcohol consumption, and 27% of patients were active smokers.Grover et al. (2018) [18] reported in their study that about one-third (31%) of the participants had tobacco dependence, and one-fifth (19.8%) of patients had alcohol dependence syndrome currently.
In this present study, 10.6% of the participants had CVDs; around 17.8% of the participants had neurological etiology, and 18.3% of the participants had respiratory etiology.Genitourinary etiology was diagnosed among 10.1% and 9.1% of the participants had GI etiology.About 8.2% of the participants had endocrinal diseases.Psychiatric etiology was present among 4.3%.Sehgal et al. (2016) [12] reported that the maximum cases (64.45%) presented with involvement of eyes, followed by musculoskeletal disorders (30.23%), cardiovascular diseases (CVD) (26.58%), respiratory system diseases (24.58%), gastrointestinal tract (GIT) diseases (19.93%), and ear diseases (11.30%) in that order.Vasanth et al. (2018) [17] reported that the presenting symptoms of the elderly patients in the inpatient ward at tertiary hospital were: Cardiorespiratory symptoms (65.5%), neuropsychiatric symptoms (63%), genitourinary symptoms (42.5%), and gastrointestinal symptoms (26%).Grover et al. (2018) [18] reported that among participants attending the medical ED, around half of the patients (47.4%) fulfilled at least one axis-I psychiatric diagnosis.morbidities were the most common (91.8%).On the other hand, among the younger age group, that is, 60-70 years psychiatric morbidities were least common (18.3%).Among the morbidities noted, CNS morbidities had a female preponderance, which was statistically significant (Tables 3 and 4).
All the participants who were smokers were diagnosed with Endocrinal morbidities.While among non-smokers 83.7% had endocrinal morbidities.The difference was statistically significant (p<0.001).All

CONCLUSION
Elderly persons have significantly higher admission rates, mortality rates, and ICU admission rates.In addition, the geriatric population has multiple comorbidities which render them susceptible to various infections and cripple their immune response.These morbidity conditions can be easily prevented by taking proper and timely measures.There is an urgent need for establishing specialist EDs and dedicated setups for geriatric population, to cater for the ever-increasing changes in demographic patterns; especially in developing countries like India.If social support, Government and economical support, and proper medical care for the elderly people can be assured; the morbidity factors can be reduced or eliminated and the fatal clinical outcome can be prevented.Thus, overall disease burden of the society can be reduced.

AUTHORS CONTRIBUTION
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