With the rapid rise in the world’s elderly population, particularly in Vietnam, there is a concomitant increasing demand for geriatric departments. What is the structure of a geriatric department? Which diseases should be paid attention to? Determining the disease patterns of older patients will contribute to the design of a comprehensive plan for elderly patients’ health care in Vietnam. In this study, we evaluated disease patterns of elderly patients hospitalized at the Vietnamese National Geriatric Hospital. We collected data from 600 inpatient medical records for patients age 60 and above who were hospitalized at the National Geriatric Hospital in 2014.
JOURNAL OF MEDICAL RESEARCH DISEASE PATTERNS OF HOSPITALIZED PATIENTS AT THE VIETNAMESE NATIONAL GERIATRIC HOSPITAL, 2014 Ho Thi Kim Thanh Hanoi Medical University, Vietnam National Geriatric Hospital With the rapid rise in the world’s elderly population, particularly in Vietnam, there is a concomitant increasing demand for geriatric departments What is the structure of a geriatric department? Which diseases should be paid attention to? Determining the disease patterns of older patients will contribute to the design of a comprehensive plan for elderly patients’ health care in Vietnam In this study, we evaluated disease patterns of elderly patients hospitalized at the Vietnamese National Geriatric Hospital We collected data from 600 inpatient medical records for patients age 60 and above who were hospitalized at the National Geriatric Hospital in 2014 A cross - sectional descriptive study was conducted to determine disease patterns among our sample The mean age of patients in our study was 75.2 years old and the most common age group was 70 - 79 years old Almost all patients had multiple comorbidities The number of diseases increased significantly with age The ten most common disorders were: hypertension (76.3%), osteoporosis (66.3%), osteoarthritis (46.3%), stroke (45.3%), insomnia (43%), diabetes (25%), constipation (24.7%), anemia (21.3%), gastritis (20%) and pneumonia (16%) The number of days spent hospitalized increased with age Several conclusions can be drawn from this study: the older patients tended to have multiple comorbidities, with an average of 6.4 disorders per patient; and the average number of days spent in the hospital was ten days, which is too short a time for most patients to recover In conclusion, the older patients in the study required significant support to meet their basic needs before discharge from the hospital Keywords: older patients, pattern disease I BACKGROUND Since 2011, Vietnam’s population has detected early to help elderly patients live begun to age dramatically Vietnam takes 17 - healthy and independent lives for as long as 20 years to double aged population (people possible Patients in the hospital usually and over) from 7% to 14%, which is shorter decline in physical strength the longer that than that of developed countries [1; 2] The they most common health problems among elderly environments and continuous, comprehensive patients are chronic conditions, particularly care is necessary to help them recover quickly non-communicable diseases [3; 4], but older after hospitalization Health care systems Vietnamese patients suffer from both acute should be reformed to cope with new disease and chronic diseases [5 - 7] Health problems patterns among elderly patients [3] Circular and declines in physical ability No 35 by the Vietnamese Ministry of Health must be remain inpatient; thus, supportive (2011) requires all general provincial hospitals Corresponding author: Ho Thi Kim Thanh, Hanoi Medical University E-mail: thanhhokim@yahoo.com Received: 20 October 2016 Accepted: 10 December 2016 JMR 105 E1 (7) - 2016 in Vietnam to establish geriatric departments It also states that Vietnam's health care system should be reformed to serve the country’s new aging population (according to 109 JOURNAL OF MEDICAL RESEARCH the WHO recommendation for age and health) [3] These requirements raise some questions: what is the structure of a geriatric department? Which diseases should be paid attention to? What knowledge about geriatric patients should be provided to doctors, nurses and caregivers? Comorbid conditions among the elderly patients are quite prevalent, but few studies have looked at this Multiple comorbidities among the elderly are linked to adverse health outcomes, including lower quality of life, psychological distress, longer hospital stays, more postoperative complications, higher cost of care and higher mortality rates Many policymakers ask, “Why we need geriatric departments when we can treat older people in other departments in the hospital?” Geriatric departments should be established to deliver coordinated care from different health specialties [8 - 10] The National Geriatric hospital provides the highest level of medical care, rehabilitation and health promotion for elderly people in Northern Vietnam This hospital plays a crucial role in providing technical support, guidelines, training courses and specialists for health Methods A cross - sectional study was conducted Rates of morbidity were determined based on a list of 19 categories of diseases included in the ICD - 10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code [11] The diagnoses were counted when they were coded in patients’ health records All acute, chronic and related disorders were counted The data was processed by SPSS 12.0 100 patients randomly selected from each department Diagnoses on admission to the hospital and complications during hospitalization were obtained prospectively using a standardized form Research ethics The research was conducted according to the principles expressed in the Declaration of Helsinki We did not have to obtain informed consent, because our research was based on medical reports III RESULTS care services targeted to elderly patients in lower We collect data from 600 hospitalized level hospitals across the country The study patients’ medical records at the Vietnamese was conducted to determine the disease National Geriatric Hospital The mean age of patterns all patients was 75.2 ± 10 years of elderly inpatients in the Vietnamese National Geriatric Hospital II SUBJECTS AND METHODS Table shows that the most prevalence disease categories among patients included in this study were diseases of the cardiovascular Subjects system (84.3%), the musculoskeletal system Medical records from 600 hospitalized and connective tissue (75.7%) and diseases patients at the Vietnamese National Geriatric relating Hospital in 2014 disorders (46.7%) 110 to mental health and behavior JMR 105 E1 (7) - 2016 JOURNAL OF MEDICAL RESEARCH Table Disease patterns among patients included in the study, according to ICD - 10 classifications Chapter Title n % I Certain infectious and parasitic diseases 20 3.3 II Neoplasms 90 15 140 23.3 III Diseases of the blood and blood-forming organs and certain disorders involving the immune system IV Endocrine, nutritional and metabolic diseases 210 35 V Mental and behavioral disorders 280 46.7 VI Diseases of the nervous system 102 17 VII Diseases of the eye and adnexa 10 1.7 VIII Diseases of the ear and mastoid process 0.7 IX Diseases of the circulatory system 506 84.3 X Diseases of the respiratory system 158 26.3 XI Diseases of the digestive system 246 41 XII Diseases of the skin and subcutaneous tissue 10 1.7 454 75.7 182 30.3 104 17.3 1.0 XIII XIV XVIII XIX Diseases of the musculoskeletal system and connective tissue Diseases of the genitourinary system Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Injury, poisoning and certain other consequences of external causes Table The ten most common diseases among hospitalized elderly patients included in this study No Disease n % Hypertension 458 76.3 Osteoporosis 398 66.3 Osteoarthritis 278 46.3 Stroke 272 45.3 Insomnia 258 43 JMR 105 E1 (7) - 2016 111 JOURNAL OF MEDICAL RESEARCH No Disease n % Diabetes 150 25 Constipation 148 24.7 Anemia 128 21.3 Gastritis 120 20 10 Pneumonia 96 16 Table indicates that hypertension (76.3%) and osteoporosis (66.3%) were common in the elderly 20.3% No insurance 46.4% Partly insurance 33.3% Fully insurance Figure The proportion of patients with medical insurance 79.7% of patients paid for their medical care using medical insurance, of which 46.4% of patients had their care paid for completely by their insurance and 33.3% of patients had their care paid for partially by insurance 20.3% of patients paid for their care by themselves Table Average number of diseases and days of hospitalization per patient in each of the different age groups Age group Total No of diseases SD Average days of hospitalization SD 60 - 69 176 4.8 2.5 9.8 7.8 70 - 79 212 6.4 2.5 11.4 8.2 80 - 89 170 7.0 2.8 11.1 11.8 > 90 42 10.3 3.8 19.4 17.0 Total 600 6.4 3.0 11.3 10.1 Table highlights the fact that the average number of diseases per patient increased with increasing age Average length of hospital stay also increased 112 JMR 105 E1 (7) - 2016 JOURNAL OF MEDICAL RESEARCH Table Classification of patient outcomes Outcome n % Outcome from hospital n % 1.3 Discharged 500 83.3 Improvement 500 83.3 Sent to other facilities 56 9.3 Worsening 88 14.6 Sent home 40 6.6 Death 0.8 Death 0.8 Total 600 100 Total 300 100 Recovery Only 1.3% of patients had a full recovery Older patients required more support and rehabilitation before going home IV DISCUSSION As people age, they are more likely to Vietnam’s population is aging at a rate that experience multiple chronic conditions This is faster than that of developed countries [17] can lead to interactions among conditions, The demand for hospital care among elderly conflicts between one condition and the patients will continue to rise Care management treatment recommendations for another condi- for elderly patients is now a top priority among tion, and negative interactions between medi- Vietnamese policymakers This survey was cations prescribed for different conditions carried on 600 older patients admitted to the Table shows that the average number of Vietnamese National Geriatric Hospital in diseases per patient among people in our 2014, with 100 patients randomly selected study increased with age The 60 - 69 year old from each department Diagnoses on admis- age group had an average of 4.8 diseases, the sion to the hospital and complications during 70 - 79 age group had an average of 6.4 hospitalization were obtained prospectively diseases, the 80 - 89 age group had an using a standardized form The hospitalized average of diseases, and the group of patients were most frequently from 70 - 79 patients aged 90 and above had an average of years old, accourting for 35.4% of the total 10.3 diseases To address the limitations of Patients age 90 and above comprised 7% of some previous studies on this topic, whose our sample, which is higher than other studies results were highly depend on the recorded of elderly patients in Vietnam This may be a clinical diagnoses in their data sets, we reflection population analyzed all patient data for the individuals Moreover, in a study conducted by Le Van included in our study A national research Tuan, Nguyen Hai Bang and Pham Thang at study conducted in Vietnam in 2002 showed the National Geriatric Hospital in 2008, the that the average Vietnamese person living in age group hospitalized most frequently was 70 the community had an average of 2.69 - 79 years, comprising 40.4% of their sample diseases Older people in the 60 - 74 year old [12] age group had 2.56 diseases, people above of Vietnam’s JMR 105 E1 (7) - 2016 aging 113 JOURNAL OF MEDICAL RESEARCH 75 years old had 3.05 diseases [5; 7] common disease was osteoporosis (66.3%), Hospitalized elderly patients included in our followed by osteoarthritis (46.3%), insomnia study had more comorbidities than a "normal" (43%), diabetes (25%), constipation (24.7%), elderly person in Vietnam As a result, the anemia impact of their multiple chronic conditions on pneumonia (16%) (21.3%), gastritis (20%) and functioning, quality of life and risk of mortality Our findings will help policy makers deter- may be significantly greater than the sum of mine the types of knowledge that providers the individual effects that might be expected serving geriatric patients in our community from these conditions Thus, older hospitalized need to have Despite the long list of diseases patients need comprehensive and continuous recorded at the National Geriatric Hospital, care These patients are often referred to as some important diagnoses are not listed and “complex elderly patients” and should be were thus not accounted for in the study, treated in geriatric department Otherwise, including frailty, fall, delirium and incontinence they will be moved from department to The National Geriatric Hospital also does not department for medical care related to each of assess for things like dependency, disabilities, their disorders impairments, social support and environmental We found that the older people in our study factors Therefore, a Comprehensive Geriatric usually suffered from several chronic disor- Assessment tool should be applied to quantify ders Table and show that admitted the patients suffered from cardiovascular diseases hospitalized geriatric patients, accompanying 84.3%, musculoskeletal and connective tis- other factors such as nutrition, mental health sues diseases (75.7%), mental and behavioral support, rehabilitation and care coordination disorders (46.7%), digestive diseases (41%), [15; 16] complexity of care needed among and endocrine, nutritional and metabolism Table highlights the fact that the propor- disorders (35%) Common reasons for hospi- tion of patients reporting full recovery was low talization were stroke, pneumonia, urinary at 1.3% The average time of hospitalization infection, hyperglycemia and hypoglycemia was 10.3 days, which is a relatively short time These results are the same as the results of a for older patients to fully recover and go home research study conducted at the National Geri- to their families The elderly may require atric Hospital in 2008 [12] According to Table longer lengths of time to recover after each 2, among the ten most common diseases in hospitalization Vietnamese elders, hypertension was the should be offered rehabilitation and chronic most prevalent (76.3%) In most research that disease care services before discharge Table has been done with geriatric patients in also highlights that the mortality rate was Vietnam, such as one study conducted at Hue 0.8% This rate may be artificially low because Central Hospital’s 115 Hospital [13] and oftentimes, when an elderly patient's condition another conducted at Binh Duong General worsens Hospital [14], hypertension and stroke were incurable, family members usually want to the most popular diseases in the hospitalized take old patients In our study, the second most prevalence 114 or Older hospitalized patients his/her patients was disease home 6.6% is deemed immediately This 46.4% the of JMR 105 E1 (7) - 2016 JOURNAL OF MEDICAL RESEARCH hospitalized patients included in this study had Wolff JL, Starfield B, Anderson G their care paid fully by their medical insurance, (2002) Prevalence, expenditures, and compli- 33.3% had their care partially paid by medical cations of multiple chronic conditions in the insurance and 20.3% of patients paid for their elderly Arch Intern Med, 162(20), 2269 - care by themselves The National Geriatric 2276 Hospital is a terminal grade hospital, so 2011 Vietnam National Aging Survey patients have to be referred by previous (VNAS) by Institute of Social and Medical hospitals in order to have their care paid by Studies, Vietnam Women’s Union, and Indo- medical insurance china Research and Consulting (also affiliated with Mekong Research Development Institute) V CONCLUSIONS funded by Atlantic Philanthropies Most elderly patients in our study had a Van Minh, Hoang, Bach Xuan Tran high prevalence of chronic medical disorders (2012) Assessing the household financial bur- Non-infectious diseases accounted for the den most morbidity and mortality The rate of multi- communicable diseases in a rural district of morbidity increased with age The most Vietnam Global health action, 5(2012) common diseases at the hospital were hyper- associated with the chronic non- Phạm Thắng (2007) Tình hình bệnh tật (66.3%), người cao tuổi Việt Nam qua số osteoarthritis (46.3%), stroke (45.3%), insom- nghiên cứu dich tễ học cộng đồng Tổng nia cục dân số - kế hoạch hóa gia đình, Bộ Y tế, tension (76.3%), (43%), osteoporosis diabetes (25%), constipation (24.7%), anemia (21.3%), gastritis (20%) and pneumonia (16%) (73) Safford MM, Allison JJ, Kiefe CI (2007) Patient complexity: more than comor- Acknowledgments We would like to acknowledge the Vietnam National Geriatric Hospital, which helped us with data collection bidity The vector model of complexity J Gen Intern Med, 3, 382 – 390 UNFPA and HelpAge International Ageing in the Twenty - First Century-A celebration and a Challenge 2012 http://www.unfpa.org/ REFERENCES UNFPA báo cáo (2011) Già hóa dân số người cao tuổi Việt Nam: thực trạng, dự báo gợi ý sách Phạm Vũ Hồng (2011) Xu hướng già hóa giới vấn đề đặt với nước phát triển Tổng cục dân số - kế hoạch hóa gia đình, Bộ Y tế, 9(126) publications/ageing-twenty-first-century 10 Wada, Taizo (2005) Depression, activities of daily living, and quality of life of community-dwelling elderly in three Asian countries: Indonesia, Vietnam and Japan Archives of gerontology and Geriatrics, 41(3), 271 - 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PLOS ONE | 13 Nguyễn Thị Thái Hằng (2002) Mơ hình bệnh tật Việt Nam phương pháp DOI:10.1371/journal.pone.0145372, 30 nghiên cứu nhu cầu thuốc đáp ứng cho mơ hình bệnh tật, Tạp chí Y học thưc hành, of Frailty and its significance in the conse- 6/2002, 41 - 44 analysis International Journal of Older People 14 Bùi Tấn Dương, Nguyễn Thanh Hn Nguyễn Văn Trí (2012) Mơ hình bệnh tật người cao tuổi điều trị bệnh viện Đa Khoa tỉnh Bình Dương năm 2011, Y Nursing, 4, 13110 - 13117 học thành phố Hồ Chí Minh, 16(4) 15 Milagros Ruiz, Alex Census Bottle, Susannah Long, Paul Aylin (2015) Multi- 116 16 Heath H, Phair L (2009) The concept quences of care or neglect for older people: an 17 Wan He, Daniel Goodkind and Paul Kowal (2016) An Aging World: 2015 U.S Bureau, International Population Reports, P95/16 - 1, U.S Government Publishing Office, Washington, DC JMR 105 E1 (7) - 2016 ... age of patterns all patients was 75.2 ± 10 years of elderly inpatients in the Vietnamese National Geriatric Hospital II SUBJECTS AND METHODS Table shows that the most prevalence disease categories... collect data from 600 hospitalized level hospitals across the country The study patients medical records at the Vietnamese was conducted to determine the disease National Geriatric Hospital The mean... Diseases of the nervous system 102 17 VII Diseases of the eye and adnexa 10 1.7 VIII Diseases of the ear and mastoid process 0.7 IX Diseases of the circulatory system 506 84.3 X Diseases of the respiratory