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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(01): 30-37
DOI: 10.1590/0004-282X-anp-2020-0091
ARTICLE

Multimorbidity and associated outcomes among older adult inpatients with neurological disorders

Multimorbidade e desfechos associados entre idosos hospitalizados com doenças neurológicas
Aroldo BACELLAR 
1   Hospital São Rafael, Departamento de Neurologia, Instituto D’Or de Pesquisa e Educação, Salvador BA, Brazil.
,
Telma ASSIS 
1   Hospital São Rafael, Departamento de Neurologia, Instituto D’Or de Pesquisa e Educação, Salvador BA, Brazil.
,
Bruno Bacellar PEDREIRA 
1   Hospital São Rafael, Departamento de Neurologia, Instituto D’Or de Pesquisa e Educação, Salvador BA, Brazil.
,
Luan CÔRTES 
2   Hospital São Rafael, Fundação Monte Tabor, Centro Ítalo-Brasileiro de Promoção Sanitária, Salvador BA, Brazil.
,
Silas SANTANA 
2   Hospital São Rafael, Fundação Monte Tabor, Centro Ítalo-Brasileiro de Promoção Sanitária, Salvador BA, Brazil.
,
Osvaldo José Moreira do NASCIMENTO 
3   Universidade Federal Fluminense, Departamento de Neurologia, Niterói RJ, Brazil.
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ABSTRACT

Background: Multimorbidity is common among adults and associated with socioeconomic deprivation, polypharmacy, poor quality of life, functional impairment, and mortality. Objectives: To identify the frequency of multimorbidity among older adults inpatients with neurological disorders (NDs), stratify clusters of chronic comorbidities associated with NDs in degrees, and verify whether multimorbidity was associated with demographic data, readmission, long length of hospital stay (LOS), and hospital mortality in this population. Methods: We enrolled patients aged ≥60 years successively admitted to a tertiary medical center with NDs between January 1, 2009, and December 31, 2010. Results: Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥60 years (mean: 75.76±9.12). Women comprised 435 (54.51%) of patients. Multimorbidity was detected in 92.61% (739) of patients, with a mean of 3.88±1.67 (median: 4.0), ranging from 2 to 10 chronic diseases. Patients with epilepsy, dementia, and movement disorders had the highest degrees of clusters of chronic morbidities (>50% of them with ≥5 chronic disorders), followed by those with cerebrovascular and neuromuscular disorders. Multimorbidity was associated with long LOS (p<0.001) and readmission (p=0.039), but not with hospital mortality (p=0.999). Conclusions: Multimorbidity was preponderant among older adults inpatients with NDs, and NDs had a high degree of associated chronic comorbidities. Multimorbidity, but not isolated NDs, was associated with readmission and long LOS. These results support ward-based, neurohospitalist-directed, interdisciplinary care for older adults inpatients with NDs to face multimorbidity.

RESUMO

Introdução: A multimorbidade é comum entre idosos e está associada a privação socioeconômica, polifarmácia, má qualidade de vida, déficit funcional e mortalidade. Objetivos: Identificar a frequência da multimorbidade entre pacientes idosos hospitalizados com doenças neurológicas (DN), estratificar combinações de comorbidades crônicas associadas às DN em graus e verificar se a multimorbidade foi associada a dados demográficos, readmissão, longo tempo de internação (TDI) e mortalidade hospitalar nessa população. Métodos: Foram incluídos pacientes com ≥60 anos sucessivamente admitidos com DN em um centro médico terciário entre 1º de janeiro de 2009 e 31 de dezembro de 2010. Resultados: Um total de 1.154 DN e 2.679 comorbidades foram identificados entre 798 pacientes com idade ≥60 anos (média: 75,76±9,12). Mulheres representaram 435 (54,51%) dos pacientes. A multimorbidade foi detectada em 92,61% (739) dos pacientes (média de 3,88±1,67; mediana de 4), variando de 2 a 10 doenças crônicas. Pacientes com epilepsia, demência e distúrbios do movimento apresentaram os maiores graus de morbidades crônicas (>50% deles com ≥5 doenças crônicas), seguidos por doenças cerebrovasculares e neuromusculares. A multimorbidade foi associada com longo TDI (p<0,001) e readmissão (p=0,039), mas não com mortalidade hospitalar (p=0,999). Conclusões: A multimorbidade foi preponderante entre os pacientes idosos internados com DN, as quais tiveram altos graus de comorbidades crônicas. A multimorbidade, mas não as DN isoladas, foi associada a readmissões e longo TDI. Esses resultados respaldam uma assistência interdisciplinar para idosos hospitalizados com DN em enfermarias lideradas por neurologistas hospitalistas para enfrentar a multimorbidade.

Keywords:

Multimorbidity - Length of Stay - Patient Readmission - Burden of Illness - Nervous System Diseases

Palavras-chave:

Multimorbidade - Tempo de Internação - Readmissão do Paciente - Efeitos Psicossociais da Doença - Doenças do Sistema Nervoso

Authors’ contributions:

AB conceived the study idea, designed the methods, collected data, performed the statistical analysis, and drafted the manuscript; TA, BBP, LC, and SS collected data, examined medical records, and reviewed manuscript drafts; LC also edited the English version; OJN discussed the study idea, methods, statistical analysis, and results. All authors discussed the findings, read, and approved the final manuscript.




Publication History

Received: 09 March 2020

Accepted: 07 June 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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