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Bökberg C, Lindhardt T, Björkman E, Ahlström G. Caring and Health of Close Family Members of Frail Older Persons Recently Discharged from Acute Hospital Care: A Comparative Cross-Sectional Study. Nurs Rep 2024; 14:901-912. [PMID: 38651481 PMCID: PMC11036298 DOI: 10.3390/nursrep14020069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
Multimorbidity in older people is strongly linked to the need for acute hospital care, and caregiving activities usually become more complex after patients are discharged from hospital. This may negatively impact the health of close family members, although this has not been comprehensively investigated. This study aimed to explore the general and mental health of close family members caring for frail older (>65) persons recently discharged from acute hospital care, making assessments in terms of gender, relationship to the older person, and aspects of caring. A comparative cross-sectional study was conducted involving 360 close family members caring for frail older persons recently discharged from hospital. The statistical analyses included subgroup comparisons and associations to caring were examined. Half of the family members reported that their general and mental health was poor, with spouses reporting the poorest health. Female participants had significantly more severe anxiety, while males had significantly more severe depression. Providing care for more than six hours per week was associated with poor general health (OR 2.31) and depression (OR 2.59). Feelings of powerless were associated with poor general health (OR 2.63), anxiety (6.95), and depression (3.29). This knowledge may provide healthcare professionals with better tools in order to individualise support, preventing family members from exceeding their resources during these demanding periods.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
| | - Tove Lindhardt
- Research Unit for Clinical Nursing, Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730 Herlev, Denmark;
| | - Eva Björkman
- Department of Care Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden;
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
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Harber-Aschan L, Darin-Mattsson A, Fratiglioni L, Calderón-Larrañaga A, Dekhtyar S. Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network. Age Ageing 2023; 52:7127659. [PMID: 37079867 PMCID: PMC10118263 DOI: 10.1093/ageing/afac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association. METHODS in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4 years in relation to SES. Stratification and statistical interaction assessed effect modification by social network. RESULTS adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493). CONCLUSION socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.
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Affiliation(s)
- Lisa Harber-Aschan
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Laura Fratiglioni
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Serhiy Dekhtyar
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
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Chen Y, Shi L, Zheng X, Yang J, Xue Y, Xiao S, Xue B, Zhang J, Li X, Lin H, Ma C, Zhang C. Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective. Int J Environ Res Public Health 2022; 19:16756. [PMID: 36554647 PMCID: PMC9779369 DOI: 10.3390/ijerph192416756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Multimorbidity has become one of the key issues in the public health sector. This study aims to explore the patterns and health-ecological factors of multimorbidity in China to propose policy recommendations for the management of chronic diseases in the elderly. (2) Methods: A multi-stage random sampling method was used to conduct a questionnaire survey on 3637 older adults aged 60 and older in Shanxi, China. Association rule mining analysis (ARM) and network analysis were applied to analyze the patterns of multimorbidity. The health-ecological model was adopted to explore the potential associated factors of multimorbidity in a multidimensional perspective. A hierarchical multiple logistic model was employed to investigate the association strengths reflected by adjusted odds ratios and 95% confidence. (3) Results: Multimorbidity occurred in 20.95% of the respondents. The graph of network analysis showed that there were 6 combinations of chronic diseases with strong association strengths and 14 with moderate association strengths. The results of the ARM were similar to the network analysis; six dyadic chronic disease combinations and six triadic ones were obtained. Hierarchical multiple logistic regression indicated that innate personal traits (age, history of genetics, and body mass index), behavioral lifestyle (physical activity levels and medication adherence), interpersonal network (marital status), and socioeconomic status (educational level) were the common predictors of multimorbidity for older adults, among which, having no family history was found to be a relative determinant as a protective factor for multimorbidity after controlling the other covariates. (4) Conclusions: multimorbidity was prevalent in older adults and most disease combinations are associated with hypertension, followed by diabetes. This shows that diabetes and hypertension have a high prevalence among older adults and have a wide range of associations with other chronic diseases. Exploring the patterns and associated factors of multimorbidity will help the country prevent complications and avoid the unnecessary use of the health service, adopting an integrated approach to managing multimorbidity rather than an individual disease-specific approach and implementing different strategies according to the location of residence.
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Affiliation(s)
- Yiming Chen
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Lei Shi
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University, Foshan 528399, China
| | - Juan Yang
- School of Health Management, Bengbu Medical College, Bengbu 233030, China
| | - Yaqing Xue
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Jiachi Zhang
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Huang Lin
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Chao Ma
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou 510515, China
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- Institute of Health Management, Southern Medical University, Guangzhou 510515, China
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MacRae C, Fisken HW, Lawrence E, Connor T, Pearce J, Marshall A, Lawson A, Dibben C, Mercer SW, Guthrie B. Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review. BMJ Open 2022; 12:e063441. [PMID: 36192100 PMCID: PMC9535173 DOI: 10.1136/bmjopen-2022-063441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use. DESIGN Systematic review reported using the synthesis without meta-analysis framework. DATA SOURCES Twelve electronic databases (1 January 2000-21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey. ELIGIBILITY CRITERIA Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English. DATA EXTRACTION AND SYNTHESIS Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed. RESULTS After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation. CONCLUSIONS There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods. PROSPERO REGISTRATION NUMBER CRD42021283515.
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Affiliation(s)
- Clare MacRae
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | | | - Thomas Connor
- The University of Edinburgh Edinburgh Medical School, Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Institute of Geography, University of Edinburgh Institute of Geography, Edinburgh, UK
| | - Alan Marshall
- Department of Social Policy, The University of Edinburgh Social Policy, Edinburgh, UK
| | - Andrew Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Dibben
- Institute of Geography, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Smith PD, Groves AK, Langellier BA, Keene DE, Rosenberg A, Blankenship KM. Eviction, post-traumatic stress, and emergency department use among low-income individuals in New Haven, CT. Prev Med Rep 2022; 29:101956. [PMID: 36161139 PMCID: PMC9502672 DOI: 10.1016/j.pmedr.2022.101956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022] Open
Abstract
We sought to examine whether and how landlord-related forced moves (inclusive of, but not limited to, legal eviction) were associated with emergency department (ED) use over time. We used survey data collected between 2017 and 2019 among 283 low-income participants in New Haven, CT to examine whether experiencing a legal eviction or other landlord-related forced move (T0) was associated with increased odds of ED use 6 months (T1) and 12 months (T2) later. We conducted bootstrapped mediation analyses to examine indirect effects of post-traumatic stress symptoms. One-fifth of participants (n = 61) reported a recent forced move at baseline (T0); half of these were legally evicted. Landlord-related forced moves were associated with ED use at T1 (AOR = 2.06, 95 % CI: 1.04-4.06) and T2 (AOR = 3.05, 95 % CI: 1.59-5.88). After adjustment for sociodemographic factors and other health-related confounders, legal eviction was not significantly associated with ED use at T1 (AOR = 1.61, 95 % CI: 0.68-3.81), but was significantly associated with ED use at T2 (AOR = 3.58, 95 % CI: 1.58-8.10). Post-traumatic stress symptoms accounted for 15.1% of forced moves' association with ED use (p <.05). Landlord-related forced moves are positively associated with subsequent ED use, and post-traumatic stress symptoms are one factor that may help explain this association. Structural interventions that promote housing stability are needed to advance health equity, and they may also help to reduce preventable ED use. Such interventions are imperative in the context of the COVID-19 pandemic, which has strained health system capacity and exacerbated housing instability for many low-income renters. Results underscore the relevance of trauma-informed care and integrated care management to clinical practice in emergency settings.
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Affiliation(s)
- Patrick D. Smith
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA
- Corresponding author at: Drexel University Dornsife School of Public Health, 3215 Market St, Office 718, Philadelphia, PA 19104, USA.
| | - Allison K. Groves
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Brent A. Langellier
- Drexel University Dornsife School of Public Health, Department of Health Management and Policy, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Danya E. Keene
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT 06510, USA
| | - Alana Rosenberg
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT 06510, USA
| | - Kim M. Blankenship
- American University, Department of Sociology, 4400 Massachusetts Avenue, Washington, DC 20016, USA
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McEntee ML, Gandek B, Ware JE. Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index. Health Qual Life Outcomes 2022; 20:108. [PMID: 35820890 PMCID: PMC9277868 DOI: 10.1186/s12955-022-02016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes.
Methods Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R2) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up.
Results In comparison with sociodemographic-only regression models (MCS R2 = 0.08, PCS = 0.09) and Charlson CCI models (MCS R2 = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R2 = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R2 = 0.31–0.38, respectively) and individualized QDIS weighting (R2 = 0.33 & 0.42). Model R2 and fit were replicated upon cross-validation. Conclusions Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02016-7.
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.
| | - Barbara Gandek
- University of Massachusetts Medical School, Worchester, MA, USA.,John Ware Research Group, Inc., Watertown, MA, USA
| | - John E Ware
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.,University of Massachusetts Medical School, Worchester, MA, USA.,John Ware Research Group, Inc., Watertown, MA, USA
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Jędrzejczyk M, Foryś W, Czapla M, Uchmanowicz I. Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome. Int J Environ Res Public Health 2022; 19:ijerph19063461. [PMID: 35329148 PMCID: PMC8950513 DOI: 10.3390/ijerph19063461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022]
Abstract
Background: Multimorbidity is a common problem worldwide. It carries the risk of reduced quality of life, disability, frequent hospitalizations, and death. The present study was designed to assess the relationships that exist between multimorbidity and disability in elderly patients. Methods: The study included 100 patients and was conducted between October 2020 and January 2021. Inclusion criteria included age >65 years, presence of a minimum of two comorbidities in the subject, and consent to participate in the study. Standardized survey instruments such as Tilburg Frailty Indicator (TFI), Charlson Comorbidities Index (CCI), Assessment of Basic Activities of Daily Living—Katz Scale (ADL), and Assessment of Complex Activities of Daily Living—Lawton Scale (IADL) were used in the study. Results: The majority of the subjects (92) had a frailty syndrome (TFI). A small group of respondents (8%) suffered from severe comorbidities (CCI). Among the subjects surveyed, 71% maintained full function in performing simple activities of daily living (ADL), while 29% demonstrated moderate disability on the scale. Full independence in performing complex activities of daily living (IADL) was present in 33% of the respondents, and 67% were partially independent. Independence in complex activities of daily living (IADL) was significantly higher in patients with fewer comorbidities. The severity of comorbidities (CCI) had a significant effect on the decrease in the level of independence (ADL and IADL). Independence in performing complex activities (IADL) was worse among older patients. Conclusions: An increase in the number of comorbidities contributes to a decrease in the level of performance of complex activities of daily living. The severity of comorbidities significantly reduces the level of independence of the subjects in simple and complex activities of daily living. In patients with a higher level of independence in performing simple and complex activities, the co-occurrence of frailty syndrome was less severe. As the age of the subjects increases, the frequency in which they show moderate dependence on third parties in performing complex activities of daily living increases.
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Affiliation(s)
- Maria Jędrzejczyk
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
| | - Weronika Foryś
- Harvard Division of Continuing Education, Harvard University, Cambridge, MA 02138-3722, USA;
| | - Michał Czapla
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Faculty of Nursing, Group in Research in Care (GRUPAC), University of La Rioja, 26006 Logroño, Spain
- Correspondence:
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
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Mitkova Z, Doneva M, Gerasimov N, Tachkov K, Dimitrova M, Kamusheva M, Petrova G. Analysis of Healthcare Expenditures in Bulgaria. Healthcare (Basel) 2022; 10:healthcare10020274. [PMID: 35206888 PMCID: PMC8872167 DOI: 10.3390/healthcare10020274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
The growth of public expenditure worldwide has set the priority on assessment of trends and establishment of factors which generate the most significant public costs. The goal of the current study is to review the tendencies in public healthcare expenditures in Bulgaria and to analyze the influence of the demographic, economic, and healthcare system capacity indicators on expenditures dynamics. A retrospective, top-down, financial analysis of the healthcare system expenditures was performed. Datasets of the National Statistical Institute (NSI), National Health Insurance Fund (NHIF), and National Center of Public Health and Analysis (NCPHA) were retrospectively reviewed from2014–2019 to collect the information in absolute units of healthcare expenditures, healthcare system performance, demographics, and economic indicators. The research showed that increasing GDP led to higher healthcare costs, and it was the main factor affecting the cost growth in Bulgaria. The number of hospitalized patients and citizens in retirement age remained constant, confirming that their impact on healthcare costs was negligible. In conclusion, the population aging, average life expectancy, patient morbidity, and hospitalization rate altogether impacted healthcare costs mainly due to the multimorbidity of older people and the rising need for outpatient hospital services and medications.
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Affiliation(s)
- Zornitsa Mitkova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
- Correspondence: ; Tel.: +359-888535759
| | - Miglena Doneva
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | | | - Konstantin Tachkov
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Maria Dimitrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Maria Kamusheva
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Guenka Petrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
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9
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Celiński M, Cybulski M, Fiłon J, Muszalik M, Goniewicz M, Krajewska-Kułak E, Ślifirczyk A. Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study. Int J Environ Res Public Health 2021; 19:48. [PMID: 35010308 PMCID: PMC8744554 DOI: 10.3390/ijerph19010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to analyse medical management in geriatric patients in the Hospital Emergency Departments in the Biała Podlaska County and Chełm County (Poland) between 2016 and 2018 in a group of patients ≥65 years of age. We analysed medical records of 829 patients transported to Hospital Emergency Departments by Medical Emergency Teams. The research was conducted in the period from June 2019 to March 2020. We analysed emergency medical procedure forms and medical records of patients transported to the hospitals. Cardiovascular diseases were diagnosed in 40% of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the Hospital Emergency Departments in more than 2/3 of cases. The concordance between the diagnoses made by the Medical Emergency Teams and those made at the Hospital Emergency Departments was confirmed for 78% patients admitted to the department (n = 647), whereas the concordance of classification at the group level was estimated at 71.7% (n = 594). Further in-patient treatment was initiated in some of the patients admitted to the department (n = 385). The mean time of hospital stay was 10.1 days. In conclusion, differences between the initial diagnosis made by the heads of the Medical Emergency Teams and the diagnosis made by the doctor on duty in the Hospital Emergency Departments depended on the chapter of diseases in the ICD-10 classification, but they were acceptable. The majority of the patients were transported to Hospital Emergency Departments. The most common groups of diseases that require Hospital Emergency Departments admission include cardiovascular diseases, injuries due to external causes, and respiratory diseases. A moderate percentage of patients were qualified for further specialist treatment in hospital departments.
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Affiliation(s)
- Mariusz Celiński
- Department of Emergency Medicine, Faculty of Health Sciences, Pope John Paul II State School of Higher Education in Biała Podlaska, 21-500 Biała Podlaska, Poland; (M.C.); (A.Ś.)
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Joanna Fiłon
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus in Toruń, 85-094 Bydgoszcz, Poland;
| | - Mariusz Goniewicz
- Interfaculty Centre for Didactics, Department of Emergency Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Anna Ślifirczyk
- Department of Emergency Medicine, Faculty of Health Sciences, Pope John Paul II State School of Higher Education in Biała Podlaska, 21-500 Biała Podlaska, Poland; (M.C.); (A.Ś.)
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Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res 2021; 21:1192. [PMID: 34732180 PMCID: PMC8567640 DOI: 10.1186/s12913-021-07216-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
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Affiliation(s)
- Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | | | - Kevin Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, SG, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore. .,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, 117545, Singapore, Singapore. .,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
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Figura A, Kuhlmann SL, Rose M, Slagman A, Schenk L, Möckel M. Mental health conditions in older multimorbid patients presenting to the emergency department for acute cardiac symptoms: Cross-sectional findings from the EMASPOT study. Acad Emerg Med 2021; 28:1262-1276. [PMID: 34309134 DOI: 10.1111/acem.14349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to (1) examine the proportion of patients presenting to an emergency department (ED) for acute cardiac symptoms with comorbid mental health conditions (MHCs) comprising current depression, generalized anxiety disorder, and panic disorder; (2) compare cardiac patients with and without MHCs regarding sociodemographic, medical, and psychological characteristics; and (3) examine recognition and treatment rates of MHCs. METHODS Multimorbid patients, aged ≥50 years, presenting to an inner-city ED with acute cardiac symptoms including chest pain, dyspnea, and palpitations, completed validated self-report instruments assessing MHCs and a questionnaire collecting psychosocial and medical information. In addition, routine medical data were extracted from the electronic health record. RESULTS A total of 641 patients were included in the study. Mean (±SD) age was 68.8 (±10.8) years and 41.7% were female. Based on screening instruments, 28.4% of patients were affected with comorbid MHCs. Patients reported clinically significant symptoms of depression (23.3% PHQ-9 ≥10), generalized anxiety disorder (12.2% GAD-7 ≥10), and panic disorder (4.7% PHQ-PD). Patients with MHCs were more likely to be younger, female, lower educated, and unemployed. The presence of MHCs was associated with higher cardiac symptom burden and subjective treatment urgency as well as more psychosocial distress (PHQ-stress) and impaired quality of life (SF-12v2). Of all patients, 15.6% were identified with new or unrecognized MHCs. CONCLUSIONS MHCs are prevalent in nearly one-third of patients presenting with cardinal cardiac symptoms. Thus, the ED visit offers an opportunity to identify and refer patients with MHCs to appropriate and timely care after exclusion of life-threatening conditions.
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Affiliation(s)
- Andrea Figura
- Department of Psychosomatic Medicine Charité–Universitätsmedizin Berlin Berlin Germany
| | - Stella L. Kuhlmann
- Division of Emergency and Acute Medicine (Campus Virchow‐Klinikum, Campus Charité Mitte) Charité–Universitätsmedizin Berlin Berlin Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine Charité–Universitätsmedizin Berlin Berlin Germany
| | - Anna Slagman
- Division of Emergency and Acute Medicine (Campus Virchow‐Klinikum, Campus Charité Mitte) Charité–Universitätsmedizin Berlin Berlin Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science Charité–Universitätsmedizin Berlin Berlin Germany
| | - Martin Möckel
- Division of Emergency and Acute Medicine (Campus Virchow‐Klinikum, Campus Charité Mitte) Charité–Universitätsmedizin Berlin Berlin Germany
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Pereira F, Wernli B, von Gunten A, Carral MDR, Martins MM, Verloo H. Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis. Geriatrics (Basel) 2021; 6:86. [PMID: 34562987 DOI: 10.3390/geriatrics6030086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients' hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75-84 years old (n = 15,485). On average, the polymedicated patients' hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263-1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.
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