Disease patterns of hospitalized patients at the Vietnamese National Geriatric Hospital, 2014

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.

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

Corresponding author: Ho Thi Kim Thanh, Hanoi Medical

University

E-mail: thanhhokim@yahoo.com

I BACKGROUND

Since 2011, Vietnam’s population has

begun to age dramatically Vietnam takes 17

-20 years to double aged population (people

and over) from 7% to 14%, which is shorter

than that of developed countries [1; 2] The

most common health problems among elderly

patients are chronic conditions, particularly

non-communicable diseases [3; 4], but older

Vietnamese patients suffer from both acute

and chronic diseases [5 - 7] Health problems

and declines in physical ability must be

detected early to help elderly patients live healthy and independent lives for as long as possible Patients in the hospital usually decline in physical strength the longer that they remain inpatient; thus, supportive environments and continuous, comprehensive care is necessary to help them recover quickly after hospitalization Health care systems should be reformed to cope with new disease patterns among elderly patients [3] Circular

No 35 by the Vietnamese Ministry of Health (2011) requires all general provincial hospitals

in Vietnam to establish geriatric departments

It also states that Vietnam's health care

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

do 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 care

services targeted to elderly patients in lower

level hospitals across the country The study

was conducted to determine the disease

patterns of elderly inpatients in the

Vietnamese National Geriatric Hospital

II SUBJECTS AND METHODS

1 Subjects

Medical records from 600 hospitalized

patients at the Vietnamese National Geriatric

Hospital in 2014

2 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 Classifi-cation 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 hospitaliza-tion were obtained prospectively using a stan-dardized form

3 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

We collect data from 600 hospitalized patients’ medical records at the Vietnamese National Geriatric Hospital The mean age of all patients was 75.2 ± 10 years

Table 1 shows that the most prevalence disease categories among patients included in this study were diseases of the cardiovascular system (84.3%), the musculoskeletal system and connective tissue (75.7%) and diseases relating to mental health and behavior disorders (46.7%)

Table 1 Disease patterns among patients included in the study,

according to ICD - 10 classifications

I Certain infectious and parasitic diseases 20 3.3

III Diseases of the blood and blood-forming organs and certain

disorders involving the immune system 140 23.3

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 4 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

XIII Diseases of the musculoskeletal system and connective

XIV Diseases of the genitourinary system 182 30.3

XVIII Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified 104 17.3

XIX Injury, poisoning and certain other consequences of

Table 2 The ten most common diseases among hospitalized elderly patients

included in this study

No Disease n %

Table 2 indicates that hypertension (76.3%) and osteoporosis (66.3%) were common in the elderly

20.3%

33.3%

Partly insurance Fully insurance

Figure 1 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 3 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

Table 3 highlights the fact that the average number of diseases per patient increased with in-creasing age Average length of hospital stay also increased

Table 4 Classification of patient outcomes

Improvement 500 83.3 Sent to other facilities 56 9.3

Only 1.3% of patients had a full recovery Older patients required more support and rehabilita-tion before going home

IV DISCUSSION

Vietnam’s population is aging at a rate that

is faster than that of developed countries [17]

The demand for hospital care among elderly

patients will continue to rise Care management

for elderly patients is now a top priority among

Vietnamese policymakers This survey was

carried on 600 older patients admitted to the

Vietnamese National Geriatric Hospital in

2014, with 100 patients randomly selected

from each department Diagnoses on

admis-sion to the hospital and complications during

hospitalization were obtained prospectively

using a standardized form The hospitalized

patients were most frequently from 70 - 79

years old, accourting for 35.4% of the total

Patients age 90 and above comprised 7% of

our sample, which is higher than other studies

of elderly patients in Vietnam This may be a

reflection of Vietnam’s aging population

Moreover, in a study conducted by Le Van

Tuan, Nguyen Hai Bang and Pham Thang at

the National Geriatric Hospital in 2008, the

age group hospitalized most frequently was 70

As people age, they are more likely to experience multiple chronic conditions This can lead to interactions among conditions, conflicts between one condition and the treatment recommendations for another condi-tion, and negative interactions between medi-cations prescribed for different conditions Table 3 shows that the average number of diseases per patient among people in our study increased with age The 60 - 69 year old age group had an average of 4.8 diseases, the

70 - 79 age group had an average of 6.4 diseases, the 80 - 89 age group had an average of 7 diseases, and the group of patients aged 90 and above had an average of 10.3 diseases To address the limitations of some previous studies on this topic, whose results were highly depend on the recorded clinical diagnoses in their data sets, we analyzed all patient data for the individuals included in our study A national research study conducted in Vietnam in 2002 showed that the average Vietnamese person living in the community had an average of 2.69

75 years old had 3.05 diseases [5; 7].

Hospitalized elderly patients included in our

study had more comorbidities than a "normal"

elderly person in Vietnam As a result, the

impact of their multiple chronic conditions on

functioning, quality of life and risk of mortality

may be significantly greater than the sum of

the individual effects that might be expected

from these conditions Thus, older hospitalized

patients need comprehensive and continuous

care These patients are often referred to as

“complex elderly patients” and should be

treated in geriatric department Otherwise,

they will be moved from department to

department for medical care related to each of

their disorders

We found that the older people in our study

usually suffered from several chronic

disor-ders Table 1 and 2 show that admitted

patients suffered from cardiovascular diseases

84.3%, musculoskeletal and connective

tis-sues diseases (75.7%), mental and behavioral

disorders (46.7%), digestive diseases (41%),

and endocrine, nutritional and metabolism

disorders (35%) Common reasons for

hospi-talization were stroke, pneumonia, urinary

infection, hyperglycemia and hypoglycemia

These results are the same as the results of a

research study conducted at the National

Geri-atric Hospital in 2008 [12] According to Table

2, among the ten most common diseases in

Vietnamese elders, hypertension was the

most prevalent (76.3%) In most research that

has been done with geriatric patients in

Vietnam, such as one study conducted at Hue

Central Hospital’s 115 Hospital [13] and

another conducted at Binh Duong General

Hospital [14], hypertension and stroke were

the most popular diseases in the hospitalized

old patients In our study, the second most

common disease was osteoporosis (66.3%), followed by osteoarthritis (46.3%), insomnia (43%), diabetes (25%), constipation (24.7%), anemia (21.3%), gastritis (20%) and pneumonia (16%)

Our findings will help policy makers deter-mine the types of knowledge that providers serving geriatric patients in our community need to have Despite the long list of diseases recorded at the National Geriatric Hospital, some important diagnoses are not listed and were thus not accounted for in the study, including frailty, fall, delirium and incontinence The National Geriatric Hospital also does not assess for things like dependency, disabilities, impairments, social support and environmental factors Therefore, a Comprehensive Geriatric Assessment tool should be applied to quantify the complexity of care needed among hospitalized geriatric patients, accompanying other factors such as nutrition, mental health support, rehabilitation and care coordination [15; 16]

Table 4 highlights the fact that the propor-tion of patients reporting full recovery was low

at 1.3% The average time of hospitalization was 10.3 days, which is a relatively short time for older patients to fully recover and go home

to their families The elderly may require longer lengths of time to recover after each hospitalization Older hospitalized patients should be offered rehabilitation and chronic disease care services before discharge Table

4 also highlights that the mortality rate was 0.8% This rate may be artificially low because oftentimes, when an elderly patient's condition worsens or his/her disease is deemed incurable, family members usually want to take patients home immediately This prevalence was 6.6% 46.4% of the

hospitalized patients included in this study had

their care paid fully by their medical insurance,

33.3% had their care partially paid by medical

insurance and 20.3% of patients paid for their

care by themselves The National Geriatric

Hospital is a terminal grade hospital, so

patients have to be referred by previous

hospitals in order to have their care paid by

medical insurance

V CONCLUSIONS

Most elderly patients in our study had a

high prevalence of chronic medical disorders

Non-infectious diseases accounted for the

most morbidity and mortality The rate of

multi-morbidity increased with age The most

common diseases at the hospital were

hyper-tension (76.3%), osteoporosis (66.3%),

osteoarthritis (46.3%), stroke (45.3%),

insom-nia (43%), diabetes (25%), constipation

(24.7%), anemia (21.3%), gastritis (20%) and

pneumonia (16%)

Acknowledgments

We would like to acknowledge the Vietnam

National Geriatric Hospital, which helped us

with data collection

REFERENCES

1 UNFPA báo cáo (2011) Già hóa dân số

và người cao tuổi ở Việt Nam: thực trạng, dự

báo và gợi ý chính sách

2 Phạm Vũ Hoàng (2011) Xu hướng già

hóa trên thế giới và các vấn đề đặt ra với các

nước đang phát triển Tổng cục dân số - kế

hoạch hóa gia đình, Bộ Y tế, 9(126).

3 WHO, World Health Organisation

Age-4 Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and

compli-cations of multiple chronic conditions in the

elderly Arch Intern Med, 162(20), 2269

-2276

5 2011 Vietnam National Aging Survey

(VNAS) by Institute of Social and Medical Studies, Vietnam Women’s Union, and Indo-china Research and Consulting (also affiliated with Mekong Research Development Institute) funded by Atlantic Philanthropies

6 Van Minh, Hoang, Bach Xuan Tran (2012) Assessing the household financial

bur-den associated with the chronic non-communicable diseases in a rural district of

Vietnam Global health action, 5(2012).

7 Phạm Thắng (2007) Tình hình bệnh tật

của người cao tuổi Việt Nam qua một số

nghiên cứu dich tễ học tại cộng đồng Tổng

cục dân số - kế hoạch hóa gia đình, Bộ Y tế, 4

(73).

8 Safford MM, Allison JJ, Kiefe CI (2007) Patient complexity: more than

comor-bidity The vector model of complexity J Gen

Intern Med, 3, 382 – 390.

9 UNFPA and HelpAge International

Age-ing in the Twenty - First Century-A celebration and a Challenge 2012 http://www.unfpa.org/ 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 - 280

11 Bộ Y tế (1997) Bảng phân loại bệnh

tật quốc tế lần thứ 10, Hà Nội, 24 – 108

12 Lê Văn Tuấn, Nguyễn Hải Hằng và

2008, Tạp chí Y học Thực hành, số 6/2009,

41 - 44

13 Nguyễn Thị Thái Hằng (2002) Mô

hình bệnh tật ở Việt Nam và các phương pháp

nghiên cứu nhu cầu thuốc đáp ứng cho mô

hình bệnh tật, Tạp chí Y học thưc hành,

6/2002, 41 - 44.

14 Bùi Tấn Dương, Nguyễn Thanh

Huân và Nguyễn Văn Trí (2012) Mô hình

bệnh tật của người cao tuổi điều trị tại bệnh

viện Đa Khoa tỉnh Bình Dương năm 2011, Y

học thành phố Hồ Chí Minh, 16(4).

15 Milagros Ruiz, Alex Bottle,

Susannah Long, Paul Aylin (2015)

Multi-Morbidity in Hospitalised Older Patients: Who

Are the Complex Elderly? PLOS ONE |

DOI:10.1371/journal.pone.0145372, 30.

16 Heath H, Phair L (2009) The concept

of Frailty and its significance in the conse-quences of care or neglect for older people: an

analysis International Journal of Older People

Nursing, 4, 13110 - 13117.

17 Wan He, Daniel Goodkind and Paul Kowal (2016) An Aging World: 2015 U.S.

Census Bureau, International Population Reports, P95/16 - 1, U.S Government

Pub-lishing Office, Washington, DC