[Morbidity of the elderly in impatient rheumatology clinic]

ABSTRACT

The improvement of life expectation in our country explains at least in part the increase of the proportion of the elderly in hospitalized patients. The aim of this study was to identify the main diseases leading to hospitalization of the aged in a rheumatology department, to establish their clinical profiles and to evaluate the quality of their management. Retrospective chart review about the elderly [age >/= 65 years] admitted in the rheumatology department of the Charles Nicolle Hospital during a 2-year-period [January 2003-December 2004]. Among the 831 patients admitted to our inpatient clinic during that period, 86 were 65-year-old or more representing 10% of the total. Mean age was 71.2 years [65-88]. The sex ratio was 1/3. A history of a mean of two associated diseases [0-5] was noted. They were dominated by hypertension [50%] and diabetes [26,7%]. Almost 1/3 of the elders had a surgical history. Gastro-intestinal troubles have been noted in only 19% of cases. The main cause of hospitalization was a diagnosis exploration [77,6%]. The remainings were admitted for therapeutic adjustment. The disease was evolving since in mean 16 months [15 days- 15 years]. The mean duration of hospitalization was 21,2 days [4-60]. The pathologies involved were varied dominated by degenerative rheumatisms [26,7%] with a predilection to lumbar spine, systemic diseases 18 cases [20,9%] with 13 cases of rheumatoid arthritis, and malignant bone diseases [18,7%]. At least two rheumatic diseases were found together in 49 patients [57%]. The clinical findings were atypical in almost half cases [42,4%] in such aged patients. Besides drugs prescribed for non rheumatic diseases, our patients took a mean of 3.4 drugs [1-8] as symptomatic, adjuvant or etiologic treatment. The treatment observance was good in 74,4% of cases. Latrogenic incidents occurred in 14 cases [16,2%]. The outcome was favorable in 68,9% of cases. Twelve of our patients necessitated a third help. Half of our patients [54%] were controlled in our outpatient clinic 1-2 months after their issue. 12 have been hospitalized for the same disease, 8 deceased, and 19 have been lost. The management of the elderly patients in hospitalization must be multidisciplinary. It should take into account the clinical and therapeutic particularities of such a population. Prevention remains the best guarantee for a good quality of life and to decrease social and economic costs