Background
Methods
The aim, design and setting of the study
Study participants’ characteristics
Data collection tool and procedure
Independent variables
Outcome variable
Outcome measurements
Sample size and sampling technique
Data management and statistical analysis
Results
Sociodemographic and behavioural variables | Frequency (%) | |
---|---|---|
Age (in years), Median (IQ) | 65 (60, 65) | |
Sex | Male | 123 (81.5) |
Female | 28 (18.5) | |
Residence | Urban | 31 (20.5) |
Rural | 120 (79.5) | |
Marital status | Married | 125 (82.8) |
Divorced | 8 (5.3) | |
Widowed | 18 (11.9) | |
Educational level | Cannot read and write | 111 (73.5) |
Nonformal education | 32 (21.2) | |
Primary education (1–8 grade) and above | 8 (5.3) | |
Patients currently working | Yes | 49 (32.5) |
No | 102 (67.5) | |
Current occupation | Retired | 20 (13.3) |
Employed | 1 (0.7) | |
Housewife | 23 (15.2) | |
Private work | 48 (31.8) | |
Nonemployed | 59 (39.1) | |
Financial dependence | Dependent | 34 (22.5) |
Independent | 117 (77.5) | |
Alcohol drinking | Never | 109 (72.2) |
Previously | 42 (27.8) | |
Cigarette smoking | Never | 111 (73.5) |
Ex-smoker | 38 (25.2) | |
Current | 2 (1.3) | |
Khat chewing | Never | 44 (29.1) |
Previously | 96 (63.6) | |
Current | 11 (7.3) | |
Traditional medicine use history | 21 (13.9) | |
Cohabitation | Live with family | 144 (95.4) |
Live alone | 7 (4.6) | |
Activities of daily living | Dependent | 59 (39.1) |
Partially dependent | 48 (31.8) | |
Fully independent | 44 (29.1) | |
Body mass index, kg/m2 | Underweight (< 18.5) | 44 (29.1) |
Normal (18.5 to < 25) | 99 (65.6) | |
Overweight (25.0 to < 30) | 8 (5.3) |
Clinical and related information | Frequency (%) | |
---|---|---|
Patients with a previous medical history | 97 (64.2) | |
Hospitalization in the previous one-year | ||
None | 101 (66.9) | |
Ones | 46 (30.5) | |
Twice | 4 (2.7) | |
Psychological condition on admission | ||
Severe dementia or depression | 28 (18.5) | |
Mild dementia | 90 (59.6) | |
No psychological problems | 33 (21.9) | |
Currently diagnosed diseases according to ICD-11 classification | ||
Certain infectious or parasitic diseases | 19 (12.6) | |
Neoplasms | 3 (2.0) | |
Diseases of the immune system | 4 (2.7) | |
Endocrine, nutritional or metabolic diseases | 35 (23.2) | |
Mental, behavioural or neurodevelopmental disorders | 118 (78.2) | |
Diseases of the nervous system | 20 (13.25) | |
Diseases of the circulatory system | 105 (69.5) | |
Diseases of the respiratory system | 68 (45.0) | |
Diseases of the digestive system | 12 (8.0) | |
Diseases of the skin | 1 (0.7) | |
Diseases of the blood or blood-forming organs | 30 (19.9) | |
Diseases of the genitourinary system | 34 (22.5) | |
Symptoms, signs, or clinical findings, not elsewhere classified | 12 (8.0) | |
Number of diseases diagnosed, Median (IQ) | 3 (3, 3) | |
Minimum, Maximum per patient | 1, 8 | |
Charlson comorbidity index, Median (IQ) score | 4 (3, 5) | |
Comorbidity severity grades based on CCI score | ||
Mild | 11 (10.5) | |
Moderate | 40 (38.1) | |
Severe | 54 (51.4) | |
Length of hospital stay (in days), Median (IQ) | 10 (6, 15) | |
Patients who took medication in the past 03 months | 71 (47.0) | |
In-hospital medications | ||
ATC code | Medications category according to ATC | |
A | Alimentary tract and metabolism | 85 (56.3) |
B | Blood and blood-forming organs | 92 (60.9) |
C | Cardiovascular system | 113 (74.8) |
H | Systemic hormonal preparations | 31 (20.5) |
J | Anti-infective for systemic use | 104 (68.9) |
M | Musculoskeletal system | 2 (1.3) |
N | Nervous system | 39 (25.8) |
P | Antiparasitic products, insecticides, and repellents | 1 (0.7) |
R | Respiratory system | 28 (18.5) |
V | Various agents | 3 (2.0) |
In hospital medications | 6 (4, 7) | |
Patients with polypharmacy (≥ 5 medications per patient) | 38 (28.2) |
Inappropriate medication use and healthcare expenditures
Specific PIMs | Frequency (%) | Beers recommendation | Reason (s) |
---|---|---|---|
Furosemide | 77 (43) | Use with caution | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults |
Tramadol | 25 (14.5) | Avoid if CrCl < 30 = 1 | CNS adverse effect |
Use with caution = 24 | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults | ||
Spironolactone | 22 (11.4) | Avoid in patients with CrCl < 30 = 2 | Increased potassium |
Use with caution = 20 | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults | ||
Ranitidine | 17 (8.8) | Reduce dose if CrCl is < 50 | Mental status changes |
Cimetidine | 13 (7.2) | Reduce dose if CrCl is < 50 | Mental status changes |
Metoclopramide | 8 (4.7) | Avoid, unless for gastroparesis with a duration of use not to exceed 12 weeks except in rare cases | Can cause extrapyramidal effects, including tardive dyskinesia; the risk may be greater in frail older adults |
Digoxin | 4 (2.1) | Avoid this rate control agent as first-line therapy for atrial fibrillation | Should not be used as a first-line agent in atrial fibrillation, because there are safer and more effective alternatives for rate control |
Aspirin and Warfarin | 3 (1.5) | Avoid when possible; if used together, monitor INR closely | Increased risk of bleeding |
Hydrochlorothiazide | 3 (2.1) | Use with caution | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults |
Amitriptyline | 2 (1.0) | Avoid | Highly anticholinergic, sedating, and cause orthostatic hypotension |
Warfarin and Ciprofloxacin | 2 (1.0) | Avoid when possible; if used together, monitor INR closely | Increased risk of bleeding |
Aspirin | 1 (0.5) | Use with caution in patients ≥ 70 years | Aspirin for primary prevention of cardiovascular disease |
Dexamethasone and NSAID | 1 (0.5) | Avoid; if not possible, provide gastrointestinal protection | Increased risk of peptic ulcer disease or gastrointestinal bleeding |
Sliding-scale regular Insulin alone | 1 (0.5) | Avoid | Insulin regimens that include only short-or rapid-acting insulin increase the risk of hypoglycemia without improvement in hyperglycemia management regardless of the care setting |
Risperidone | 1 (0.5) | Avoid | Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium |
Number of PIMs | Healthcare expenditures, ETB | |||||
---|---|---|---|---|---|---|
Frequency (%) | Bed costs | Medication costs | Medical supply cost | Investigation costs | Total costs | |
None | 40 (26.5) | 96 (72, 144) | 824 (538.5, 1302.5) | 210 (180, 280) | 1564 (975, 1984) | 2902.5 (2181.5, 3966.9) |
One | 59 (39.1) | 120 (72, 156) | 824 (442.9, 1265) | 155 (110, 250) | 1720 (1126, 2450) | 2884 (2150, 3912) |
Two | 37 (24.5) | 144 (84, 180) | 824 (566, 1405) | 233 (154, 328) | 1800 (1281, 2350) | 3051 (2410, 4055) |
Three and above | 15 (9.9) | 166 (72, 240) | 824 (630, 1680) | 240 (130, 325) | 2250 (1870, 2710) | 4042 (3478.7, 4897) |
p-value | 0.153 | 0.525 | 0.025* | 0.033* | 0.023* |
Factors associated with older adult patients’ healthcare expenditure
Variables | Unadjusted B (95%CI) | p- value | Adjusted B (95%CI) | p-value |
---|---|---|---|---|
Number of PIMs (reference: No PIM) | 0.044 | |||
One PIM | -0.042 (-0.238, 0.153) | 0.670 | -0.162 (-0.329, 0.004) | 0.056 |
Two PIMs | 0.111 (-0.107, 0.328) | 0.319 | -0.174 (-0.369, 0.021) | 0.080 |
Three and above | 0.265 (-0.023, 0.554) | 0.072 | -0.028 (-0.283, 0.227) | 0.832 |
Female sex (reference: Male) | -0.178 (-0.378, 0.022) | 0.081 | -0.181 (-0.265, -0.048) | 0.175 |
Financial dependence (reference: Dependent) | ||||
Independent | 0.259 (0.076, 0.441) | 0.005 | -0108 (-0.257, 0.040) | 0.153 |
Traditional medicine use (reference: no) | -0.176 (-0.401, 0.048) | 0.124 | -0.012 (-0.189, 0.166) | 0.899 |
Patients with endocrine, nutritional or metabolic diseases (reference: without) | 0.161 (-0.024, 0.345) | 0.089 | 0.115 (-0.022, 0.251) | 0.101 |
Patients with diseases of the nervous system (reference: without) | -0.307 (-0.533, -0.082) | 0.008 | -0.307 (-0.502, -0.112) | 0.002* |
Patients with diseases of the respiratory system (reference: without) | -0.126 (-0.282, 0.030) | 0.114 | -0.196 (-0.327, -0.065) | 0.003* |
Patients with symptoms, signs or clinical findings, not elsewhere classified (reference: without) | -0.183 (-0.474, 0.108) | 0.217 | -0.131 (-0.356, 0.094) | 0.251 |
Number of in-hospital medications, count | 0.087 (0.062, 0.113) | 0.000 | 0.068 (0.035, 0.101) | < 0.001* |
Patients with blood‒blood-forming organ medication prescription (reference: no) | 0.304 (0.154, 0.453) | < 0.001 | 0.151 (0.005, 0.297) | 0.042* |
Patients with systemic hormonal medications prescription (reference: no) | 0.146 (-0.049, 0.342) | 0.142 | -0.009 (-0.174, 0.156) | 0.916 |
Patients with antiinfectives for systemic use prescription (reference: no) | 0.247 (0.085, 0.409) | 0.003 | 0.113 (-0.034, 0.260) | 0.133 |
Patients with nervous system medications prescription (reference: no) | 0.179 (0.0003, 0.357) | 0.050 | 0.045 (-0.102, 0.191) | 0.550 |
Length of hospital stay, days | 0.007 (0.002, 0.012) | 0.010 | 0.003 (-0.001, 0.007) | 0.146 |