OLDER ADULTS HOSPITALIZED IN A TEACHING HOSPITAL : CLINICAL CHARACTERISTICS AND OUTCOMES

Objective: to investigate the causes of older adult hospitalizations, demographic and clinical profiles, and patient outcome. Method: quantitative cross-sectional study conducted with 14,892 electronic medical records during 12 months. We carried out a descriptive analysis of the variables of the sample characterization, and an associative test using chi-square statistics. Results: most patients assessed were male, had primary education, lived with a partner, were white and Catholics, and had cardiovascular diseases, followed by neoplasms and gastrointestinal diseases in both sexes. The average age of the patients was 72.1 years, and the average length of hospital stay was 5.9 days. There was a significant association between diagnosed diseases, sex (p <0.001), and ethnicity (p = 0.023) of the patients. The most common outcome was hospital discharge. Conclusion: chronic diseases were the main causes of older adult hospitalizations and led to increased length of hospital stay. The assessment of these factors provides subsidies for identifying problems and performing best nursing interventions. Descriptors: Older Adult; Hospitalization; Clinical Evolution. RESUMO Objetivo: investigar as causas de internação dos idosos hospitalizados, o perfil demográfico, o perfil clínico e o desfecho. Método: estudo quantitativo, transversal de análise de 14.892 prontuários eletrônicos, no período de 12 meses. Foi realizada uma análise descritiva das variáveis de caracterização amostral e aplicação do teste associativo pela estatística qui-quadrado. Resultados: a maioria dos pacientes avaliados era do sexo masculino, com grau de instrução fundamental, com companheiro, do lar, brancos, católicos e com doenças cardiovasculares, seguidas de neoplasias e doenças gastrointestinais em ambos os sexos. A idade dos pacientes apresentou média de 72,1 anos e a média da permanência hospitalar foi de 5,9 dias. Houve associação significativa entre as doenças diagnosticadas, o sexo (p <0,001) e a etnia (p = 0,023) dos pacientes. O desfecho mais comum foi a alta dos pacientes. Conclusão: as doenças crônicas foram as principais causas de hospitalização dos idosos, acarretando mais tempo na hospitalização. A investigação destes fatores fornece subsídios para identificação dos problemas e realizar melhores ações de enfermagem. Descritores: Idoso; Hospitalização; Evolução Clínica. RESUMEN Objetivo: investigar las causas de hospitalización de adultos mayores, perfil demográfico, perfil clínico y desenlaces. Método: estudio cuantitativo transversal con análisis de 14.892 registros médicos electrónicos de un período de 12 meses. Se realizó un análisis descriptivo de las variables de caracterización de la muestra y se aplicó la prueba chi-cuadrado. Resultados: la mayoría de los pacientes evaluados eran hombres, con educación primaria, vivían en pareja, eran blancos, católicos y tenían enfermedades cardiovasculares, seguidas de neoplasias y enfermedades gastrointestinales en ambos sexos. El promedio de edad de los pacientes fue de 72,1 años y de la estancia hospitalaria fue de 5,9 días. Hubo una asociación significativa entre enfermedades diagnosticadas, sexo (p <0.001) y etnia (p = 0.023) de los pacientes. El resultado más común fue el alta hospitalaria. Conclusión: las enfermedades crónicas fueron las principales causas de hospitalización de los adultos mayores, llevando a un tiempo más prolongado de internación. La investigación de estos factores proporciona subsidios para identificación de problemas y realizar mejores intervenciones de enfermería. Descritores: Adulto Mayor; Hospitalización; Evolución Clínica. Nurse, Master’s Degree in Nursing, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mails: ca.c.rodrigues@hotmail.com; samaris.enf@hotmail.com; Nurse, Ph.D., Professor at the Department of General Nursing and the Nursing Graduate Program, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mails: ricardo.rita@terra.com.br; claudiacesarino@famerp.br; Nurse, Ph.D., Professor at the União das Faculdades dos Grandes Lagos University (UNILAGO) and the Nursing Graduate Program, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. Email: danielacomelisbertolin@gmail.com; Nurse, Master’s Degree candidate in Nursing, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mail: rib_renato@hotmail.com; Nurse, Ph.D., Professor at the São José do Rio Preto School of Medicine (FAMERP), University of São Paulo (USP). Ribeirão Preto, SP, Brazil. E-mails: mariliapilotto@yahoo.com.br; kusumota@eerp.usp.br ORIGINAL ARTICLE Rodrigues CC, Ribeiro RCHM, Cesarino CB et al. Older adults hospitalized in a teaching...

English/Portuguese J Nurs UFPE on line., Recife, 11 (12):4938-45, Dec., 2017  4939 We experience a permanent aging process from birth to death.Senility is the last stage of the natural evolution of life.It is characterized by a succession of biological, economic, and political and social parameters changes that are part of the everyday life of these individuals at this stage. 1e older adult population has been exhibiting a greater growth rate than the total population.Due to its characteristics, this population has implications for planning the social and economic development of a country, since the main objective is to qualitatively improve the health of this age group of the population in order to achieve better quality of life. 2 One of the main impacts of population aging is the change in the morbimortality profile, which is characterized by significant increase in the occurrence of chronic degenerative diseases. 3ta on the health situation and the need for medical attention are paramount for planning prevention strategies, healthcare, and health promotion.Brazil has a high rate of hospitalizations and rehospitalizations among individuals aged 60 years or more.Consequently, healthcare cost in this age group is also greater than in the other age groups. 4e to the decreased ability to respond to stress, and the greater vulnerability of this age group, the diseases that trigger the hospitalizations of older adults require permanent and intensive care.In these cases, family support and follow-up are of great importance. 5n the other hand, hospitalizations cause suffering to older adults, because, when they are away from their social context, they lose a part of their autonomy, particularly with respect to their habits, behaviors, and routines, which are changed by the hospital routine. 6e health profile of older adults should be assessed by health professionals and their managers.The goal of this procedure is to develop strategies for health promotion and prevention of diseases and their harms.In this way, there will be improvement in the quality of life of this population and a greater access to healthcare. 7sed on these aspects, we carried out an exploratory research to investigate the causes of hospitalizations that most affect hospitalized older adults.We assessed the demographic and clinical profiles of these older adults and their outcomes after hospitalization (hospital discharge or death).
We believe that these causes can be prevented and treated if diagnosed early.This is a quantitative, documentary, retrospective, cross-sectional study.We assessed the electronic medical records of older adult patients cared for in the in-patient units of a teaching hospital, located in the State of São Paulo, Brazil, from January 2014 the December 2014.The purpose was to determine the causes of hospitalizations, the demographic and clinical profiles of these older adults, and their outcomes after hospitalization.The aforementioned hospital functions as a reference center for the local population, nearby towns, and even other states.It has state-of-the-art technology to treat its patients.
The sample consisted of 14,892 medical records of older adult patients aged over 60 years, cared for during 12 months in the inpatient units of the hospital.Older adult patients who had been hospitalized during the entire length of stay in the emergency or intensive care units were excluded from the study.
The parameters studied in the medical records were the demographic data, such as age, sex, ethnicity, marital status, and occupation.We also analyzed clinical variables, such as reasons for hospitalizations, type of hospitalization (clinical or surgical), and patient outcomes.
For the descriptive analysis of sociodemographic and clinical data, we used measures of location, dispersion, and variability (average, standard deviation, maximum and minimum).For quantitative and categorical variables, we used simple frequency (number and frequency).For the association between the diseases diagnosed, sex, and ethnicity, we used the chi-square test.The results indicate that, of the patients assessed, 8,014 (53.8%) were male, 9,183 (68%) had primary education, 8,750 (62.4%) lived with a partner, and 4,652 (33.1%) were housewives, followed by 3,595 (25.6%) workers in the service sector, 13,902 (93.5%) were white, and 11,291 (80.2%) were Catholic.
Table 2 shows the percentage of clinical variables of the patients assessed in the study.The average age of the patients was 72.1 years, with standard deviation of 8.6 years and average of 71 years.The data did not follow the normality assumption, due to the presence of several discrepant high values.The minimum age was 60 years and the maximum 103 years.The average length of hospital stay was 5.9 days, with a standard deviation of 8.8 days, and average of three days.The minimum length of hospital stay was one day and the maximum 227 days.The data did not follow the normality assumption and length of stay distribution exhibited several discrepant high values.
Table 3 shows the association between diseases diagnosed, sex, and ethnicity.It is worth noting that, to enable this analysis, non-white patients were grouped into a single group called non-white ethnicity.The results of Table 3 indicate a significant association between diseases diagnosed, sex (p <0.001), and ethnicity (p = 0.023) of the patients.In the case of the association between diseases and sex, most diseases diagnosed had occurred more often in male patients.However, endocrine, gynecological, neurological, and orthopedic diseases, as well as cases of pain, had been more frequent in female patients.
With respect to ethnicity, all cases of diseases were more prevalent in white patients.However, the association was linked to the fact that there was a greater difference between the percentages of disease occurrence among non-white older adults.For these patients, the most frequent diseases were neurological, endocrine, skin diseases and traumas, followed by infections and other diseases.These diseases mentioned had percentage scores close to 10%.These values represent an enough difference to promote significant association between diseases diagnosed and the ethnicity of the patients assessed in the study.
Concurrent with population aging, it is also possible to observe an increase in chronic diseases and their complications.This In this context, it is also possible to note a proportional increase between chronic diseases and the number of older adult hospitalizations.In addition, the length of hospital stay increases accordingly. 9garding the data obtained in the present study, there was a predominance of male patients.The low demand for health services in basic healthcare units and greater exposure to external factors can contribute to that finding.  The compliance of men with disease prevention programs is related to the cultural belief that man should be invulnerable, strong, and manly.Such concepts would be weakened by seeking health services.In this way, individuals seek health services when the problems become unbearable, which causes the highest number of hospitalizations, complications, and deaths. 12e low level of education found is related to the difficulty of access to education that occurred in the past, since the incentive to study and its appreciation have been more recently intensified, thus reaching younger age groups. [13]Average age of 72 years, white ethnicity, and being married are in line with data found in other studies. 14rdiovascular diseases were the main reasons for hospitalizations.Another study conducted in Maceió, State of Alagoas, Brazil, also pointed out a greater number of older adult hospitalizations due to circulatory diseases. 15 addition to being the leading cause of hospitalizations, cardiovascular diseases are also the leading cause of death among older adults, for both younger (60-79 years) and long-lived (over 80 years), the latter being even more important.Just as in the present study, a study conducted in the State of Rio Grande do Norte, Brazil, also pointed out neoplasms and diseases of the gastrointestinal tract as causes of mortality among older adults. 16e Family Health Strategy performs actions for disease prevention, health promotion, and minimization of damages.This national project is important for the reduction of acute processes of circulatory diseases and, consequently, the reduction in the number of older adult hospitalizations. 17e main outcome of the older adults was hospital discharge.The average length of hospital stay in the in-patient units was 5.9 days (standard deviation = 8.8 days) and the median was 3.0 days.Nursing care is fundamental for patient outcomes.Early planning of hospital discharge performed by the nursing team, together with the multidisciplinary team, reduces the number of iatrogenic events, functional decline, length of hospital stay, bad outcomes after hospital discharge, mortality, and the number of rehospitalizations. 18der adult patients demand extensive healthcare from the nursing team.However, the number of these health professionals, for the most part, falls short of what is needed.In this way, healthcare quality is compromised, contributing to a greater number of problems, such as pressure ulcers and falls.In addition, this low quality hinders the identification of each patient's needs. 19other important factor is the referral and counter-referral of patients from the Family Health Strategy to hospital units.Communication between primary and tertiary healthcare facilitates hospital discharge planning, and promotes the necessary adjustment so that individualized health care can be effective. 20though most diseases were prevalent in men, some had a higher percentage of occurrences, such as neoplasms, hematological diseases, nephrorological diseases, and traumas.As previously mentioned, men tend to resort less to medical appointments and seek emergency care.This fact leads to the aggravation of these diseases and a higher rate of male mortality. 21udies carried out in the southern and the northern regions of Brazil indicated a greater number of services provided due to trauma in female older adults.This finding differs from what we found in our study.Those studies have also indicated falls as the main cause of trauma among older adults.  Theh number of falls in older adults can be directly related to the fragility syndrome, whose one of its main features is gait changes.Studies show that this syndrome mainly affects long-lived older adults and female older adults, resulting in the risk of falls. 24th respect to hematologic diseases, a study conducted in the State of Minas Gerais, Brazil, indicated the prevalence of anemia, which had also been more frequently observed in men. 25 On the other hand, neoplasms did not show significant differences between sexes according to a study conducted in the State of Rio Grande do Sul, Brazil.That study English/Portuguese J Nurs UFPE on line., Recife, 11 (12):4938-45, Dec., 2017 4943

DISCUSSION
found that breast cancer was more prevalent in women and prostate cancer in men. 26ong nephrorological diseases, urinary tract infection has great prominence among older adults due to multiple factors, such as anatomical and functional changes of the urinary tract and urinary incontinence, among others.Literature data suggest a higher incidence of urinary tract infections in female older adults, which differs from the data found in the present study. 27is present study made it possible to confirm that chronic diseases were the leading causes of older adult hospitalizations.In addition, cardiovascular diseases were the main cause of such hospitalizations.Increased survival rate has also led to a greater occurrence of chronic diseases, thus causing increased length of hospital stay.The assessment of these factors provides subsidies for identifying problems and performing best nursing interventions.
Actions directed to the prevention of these diseases in the framework of basic healthcare are of great importance for a change in this Brazilian panorama.It is also important to define strategies for controlling and preventing the worsening of chronic diseases.
The training provided to older adults' caregivers by a multidisciplinary team during hospitalization, and the development of early plans for hospital discharge, as well as performing counter-referral to basic healthcare services, are contributing factors to avoid rehospitalizations.
The main limitation of the present study was the impossibility to obtain data that might haver contributed to the research-such as pre-existing comorbidities-via the system used in the institution where the study was conducted.Data such as the presence of diabetes and hypertension would contribute to a broader view of these older adults' health profile.

Table 1 .
Variables of the sample characterization of older adult patients cared for in the in-patient units of a teaching hospital.São José do Rio Preto (SP), Brazil, 2014.

Table 3 .
Association between diseases diagnosed, sex, and ethnicity of older adult patients cared for in the in-patient units of a teaching hospital.São José do Rio Preto (SP), Brazil, 2014.