SOCIO-DEMOGRAPHIC AND CLINICAL PROFILE OF OLDER PATIENTS ASSISTED IN A PHILANTHROPIC INSTITUTION IN THE INTERIOR MINAS GERAIS

Objective: to determine the socio-demographic and clinical profile of the elderly population in a philanthropic institution in the interior of Minas Gerais. Methods: this is a documentary, retrospective, descriptive study, in which the medical records of the older adults hospitalized from January to October 2017 were analyzed. The sample calculation was performed by the central limit theorem, resulting in 400. The nonparametric Mann-Whitney statistics were used in the median analysis. For the analysis of categorical variables, Pearson's chi-square test was used. The significance level was set at 5%. Regarding the socio-demographic data, 35% of the elderly participants were older than 80 years old, 52.7% were male, 36% were married, 74.8% had comorbidities, and 70.9% were on medication. Results: the association between comorbidities and medication use was significant (p = 0.0002). Regarding clinical data, the main hospitalization diagnoses were related to the cardiovascular system (26.8%), and the association between hospitalization diagnosis and significant clinical evolution (p <0.001). The readmission rate was 42.5%. The length of stay prevailed between one and ten days (79%) and clinical evolution to discharge (74.8%) prevailed when compared to death (19.8%). The association between length of stay and clinical evolution was significant (p = 0.005). Conclusion: this study may have positive implications to improve the quality of care of the elderly population since the socio-demographic and clinical profile of these patients enables the generation of health indicators, essential for reducing length of stay, morbidity and mortality rates and readmissions.


INTRODUCTION
Population aging is a socio-demographic scenario worldwide that has been growing, especially in developing countries. 1,2The elderly person is defined as those aged 60 or older in developing countries and those aged 65 or older in developed countries. 3he aging process can generate economic, social, and epidemiological impacts in the country, once the older adultt ends to gradually lose their organic and physiological functions besides losing their professional bond. 4,5][4][5] The high prevalence of hospital readmissions contributes to the reflection on social, health and welfare demands, which implies the incidence of hospitalizations. 2 The hospital readmission rate of the elderly population in the United States (USA) was 18.3% in patients with acute myocardial infractions, 23% in patients with congestive heart failure and 17.6% in patients with pneumonia. 5Readmission rates in the USA averaged 18.4%, which could result in overspending of approximately $ 17 billion per year, and exposing the patient to risks of infection and functional loss. 5n Brazil, 31.42% of hospitalization costs are from individuals older than 60 years old. 6The elderly Brazilian population went from 9.7% in 2004 to 13.7% in 2014.According to the projection of the population performed by the Instituto Brasileiro de Geografia e Estatística of 2013, this increase could reach 18.6% in 2030 and 33.7% in 2060. 7he hospitalization rate and bed occupancy rate are much more prevalent and prolonged in elderly people, especially when associated with cardiovascular diseases. 1,8,9Epidemiological studies confirm that the main causes of hospitalization in the elderly population are the cardiovascular system. 1,8,9lthough these three studies have the highest prevalence of cardiovascular disease (32.55%, 44.13%, and 24.8%), the second leading cause varied among them. 1,8,9While one study found the diseases related to the respiratory system as a second cause with a rate of 27.9%, and the other two studies reported neoplasms with rates of 24.72% and 13. 1%, respectively. 1,8,9he prevalence of chronic non-communicable diseases, especially cardiovascular, respiratory, and neurological diseases, increase considerably in the elderly population, and they are risk factors for hospitalization and mortality. 10The identification of these factors can generate health indicators, essential for improvement of the surveillance and the quality of care for hospitalized elderly patients. 10he hospitalization of the older people may not indicate an improvement in their clinical condition of hospitalization; however, it may lead to decreased quality of life and the appearance of complications unrelated to the problem that led to hospital admission. 11,12The severity of clinical conditions and pathological disorders in the elderly population and inadequate monitoring can lead to disabling adverse reactions, increasing the incidence of readmissions in elderly people. 1 Understanding the socio-demographic and clinical profile of the elderly population is relevant for both clinical practice and the scientific community, as it enables the development of effective institutional actions that will be specific to each elderly population.Such actions strengthen health services to improve detection and control of chronic diseases, comorbidities and risk factors that they can lead to readmissions and increased morbidity and mortality during hospital stay if not identified. 2everal studies have evaluated the epidemiological profile of hospitalized elderly patients, showing the importance of raising demands and planning differentiated care for these possibilita a geração de indicadores de saúde, essenciais para a redução do tempo de internação, taxas de morbimortalidade e reinternações.Palavras-chave: Assistência a Idosos; Saúde do Idoso Institucionalizado; Estudos Retrospectivos; Enfermagem.
from the present study to define a specific and characteristic profile of inpatient units.Critically ill older people may have differentiated needs for treatment and clinical involvement that may influence the specificity of the profile of those admitted to the inpatient units.
The collected data were categorized and analyzed in the Statistical Package for the Social® software version 20 (SPSS).The descriptive statistical methods analyzed the variables and, after finding the rejection of the hypothesis of normality of data through the Kolmogorov-Smirnov test, medians and quartiles were used.The median analysis used nonparametric Mann-Whitney statistics.For the analysis of categorical variables, Pearson's chi-square test was used.A significance level of 5% was used for all analyses performed.
The Research Ethics Committee of the Universidade Federal dos Vales do Jequitinhonha e Mucuri approved the research under the number 2,468,631 of 2017.

RESULTS
The study found that 2,058 (46.42%) of 4,433 hospitalizations were elderly patients.From these 2,058 older adults, the sample size calculation selected 400 records for data collection, with 134 (33.5%) of them having patients aged 60 to 69 years old, 126 (31.5%) having patients aged 70 to 79 years old and 140 (35%)having patients above 80 years old.
The socio-demographic profile and length of stay of the elderly hospitalized in the study institution are shown in Table 1.
In this study, the following variables were considered "factors that prolong the length of stay": smoking had 48 (12.0%), alcoholism had 30 (7.5%), mental disorders had 25 (6.3%), dementia had 18 (4.5%),and depression had eight (2.0%) patients.Of the total hospitalized, 77.3% of the medical records did not contain information on these factors.
The hospitalization diagnoses were organized into the following groups: cardiovascular, respiratory, digestive, urinary, neurological, infections, neoplasms, and others.The main causes of hospitalizations found were those related to the cardiovascular system prevailed with 107 patients (26.8%):CHF (10.3%), acute myocardial infarction (2.3%), unstable people. 1,8,9,12There is still a gap in scientific knowledge regarding the clinical profile, social and demographic characteristics of the elderly population in regions of the interior of Brazil that still require specific and individualized care demands for better surveillance and positive impact on the care of this population.With this challenge, this study aimed to determine the sociodemographic and clinical profile of the elderly population in a philanthropic institution in the interior of Minas Gerais.

METHODOLOGY
This is a descriptive and retrospective study conducted from January to October 2017 in a philanthropic institution in Diamantina -MG, Brazil.The city of Diamantina is located in a region called Alto Jequitinhonha, highlighted by the large discrepancy between the population covered by an expanded health region (1,000,000 inhabitants) and the population of the expanded Jequitinhonha health region (374, 199 inhabitants). 13his study was held in a philanthropic institution of medium size and with 100 hospitalization beds.These beds are distributed in clinics (medical, surgical, neurological, and covenants) and intensive care center.
During the study period, 4,433 patients of all ages were hospitalized, in which 2,058 were aged 60 years old or over, of both genders, in medical, neurological, surgical, and covenants clinics.The sample size calculation was performed based on the central limit theorem, which describes the mean distribution of a random sample from a non-normal population with finite variance, calculated using a 95% confidence interval, resulting in 400 participants.These 400 records were obtained by simple random draw.The sample loss was 28%, due to the lack of information contained in the medical records, so 112 medical records were replaced.
The authors built the data collection instrument according to the parameters studied in the medical record.][16] The datasheet was composed of the following variables: socio-demographic (gender, age, origin, and marital status) and clinical (medical diagnosis, length of stay, readmissions in the year, clinical evolution -discharge, transfer or death -, comorbidities and factors that extend the length of stay).The medical records were coded to avoid the identification of the individuals.
The inclusion criteria were all the medical records of patients admitted to the medical, neurological, surgical, and covenants clinics of the institution, of both genders, aged 60 years old or older.Those patients who did not have an online medical record were excluded from this study.The elderly admitted to the intensive care unit were also excluded DOI: 10.5935/1415-2762.20190060 Socio-demographic and clinical profile of older patients assisted in a philanthropic institution in the interior Minas Gerais angina (3.8%) and total atrioventricular block (2.5%).The second major cause of hospitalization was the neurological group with 105 patients (26.3%): stroke (14.1%), chronic and acute subdural hematoma (4.6%) and head trauma (1.5%).
The association between the diagnosis of hospitalization and clinical evolution showed a significant result, p <0.001.In the main causes that led the patients to death, 33.3% were related to the respiratory system, 14.9% to the cardiovascular system and 11.4% to the neurological system.
Two hundred and thirty (57.5%) of the 400 hospitalizations were from the elderly patients admitted for the first time in the institution, and 170 (42.5%) were those with at least two hospitalizations in the year.
The associations between length of stay and diagnosis of hospitalization, comorbidities, and clinical evolution of the elderly are shown in Table 2.
The association between readmissions and origin and comorbidities is shown in Table 3.
Table 4 shows the associations between the gender and clinical evolution and marital status of the patients.There is a cross between comorbidities and clinical evolution and regular use of medication at home.
Table 5 shows the associations between age groups and comorbidities, the number of medications used regularly at home, reasons for hospitalization and clinical evolution.

DISCUSSION
The prevalence of elderly inpatients during the study period was 46.42% of the total hospitalizations.A crosssectional epidemiological study found a prevalence of 33.96% of the elderly patients in the total of hospitalized patients in the state of Minas Gerais in a study period similar to this study. 7he high rate of hospitalized elderly patients can be by the increasing prevalence of older adults seeking the tertiary care sector because of the possible aggravation of pre-existing diseases. 7Also, the lack of systematic control and surveillance measures in primary health care, lead older people to increase the demand for tertiary services. 9he highest rate of hospitalized elderly patients was in the age group above 80 years old (35%).A cross-sectional study conducted in Salvador, Bahia and another cohort study in the city of Sete Lagoas, Minas Gerais on the prevalence of elderly inpatients in health institutions also identified high rates in this age group, with 43.8 and 50.4%, respectively. 12,14][17] Prospective observational research conducted in Paris, France, revealed that older people between 80 and 89 years old had a high rate (72%) of comorbidity associated with a history of heart failure and arterial fibrillation, contributing to increasing the length of hospital stay. 17ost elderly patients in this study were male (52.7%).Descriptive studies conducted in Niterói, Rio de Janeiro -RJ and the interior of São Paulo -SP obtained a prevalence of 58. 1 and 53.8%, respectively, of elderly male inpatients. 1,9The low participation of men in preventive actions associated with external factors such as smoking and alcoholism expose men to greater vulnerability and, consequently, tend to have more readmissions compared to women. 9Other studies have found that men's increased demand for health institutions usually happens when there is an exacerbation of its clinical and pathological condition. 9,15owever, a descriptive epidemiological study conducted in Fortaleza, Ceará to define the profile of elderly inpatients found female prevalence (56%) when compared to male.  This was rate similar to this study with 70.9%.Such rates may be justified by the demographic transition in the epidemiological profile of the population.The current trend is to reduce the occurrence of infectious and parasitic diseases and to increase the prevalence of chronic degenerative diseases. 15n this research, the prevalence of the following comorbidities were found: SAH 57.3%, DM 20.5%, COPD 18.5% and CHF 4.8%.Physiological complications from these diseases and inadequate treatment can cause hospitalizations and become a risk factor for death. 10uch comorbidity rates are dependent on the region and the specific profile of each health institution.Similar results of prioritizing comorbidities in the elderly population were also found in a European prospective multicenter observational study, with a prevalence of 79% of hypertensive patients, 33% diabetic and 43% with CHF. 17 Another cross-sectional study conducted in Natal, Rio Grande do Norte found the following order of classification of comorbidities: SAH 50%, DM 25.5%, arthritis/arthrosis 17%, osteoporosis 12.8% and heart disease 8.5%. 2 In this study, the most prevalent marital status in the elderly patients of both genders was the married situation (36%).Two descriptive studies conducted in Rio de Janeiro and Fortaleza, Ceará also assessed the profile of the hospitalized elderly population and identified similar rates of 46.5, 42.6%, respectively. 1,11n this study, a significant difference (p<0.05) was found between marital status and male and female gender.This data was also found in a retrospective observational study to describe the profile of the elderly population in Italy. 16arried participants were more prevalent in male (64.9%) and widowhood in female (79.1%).This study conducted in Italy corroborates the findings of this investigation with similar rates of 57.6% of married men and 74% of widowed women. 16This data can be explained by the greater survival of the female population, considering that men more often exposed to lifethreatening situations such as motor vehicle incidents, leading to increased mortality rates. 11Also, men are more likely to remarry after widowhood. 147][18][19] Such comorbidities may influence the regular use of medication.Other factors such as social, educational level, and cognitive impairment may also impact medication use. 18,19][19] A multicenter prospective study of European elderly aged 75 years and over showed that 40% of them had some dementia. 17However, in this study, only 4.5% of the hospitalized elderly patients had diagnosis and previous treatment for some dementia.
According to the WHO, although affecting mainly the elderly population, dementias are not diseases of aging. 18his statement may justify the rate found in this study with 4.5% when compared to other diagnoses of hospitalizations.However, age versus dementia in this investigation had a significant value (p<0.05).
In this study, 12% of the hospitalized elderly were smokers.A retrospective European medical analysis research reported that 16% of elderly inpatients were smokers. 16he main hospitalization diagnoses of this study were related to the cardiovascular (26.8%), neurological (26.3%), and respiratory (14.2%) systems.Quantitative research conducted in Maceió, Alagoas, corroborates this finding as the first cause of hospitalization, with 44.13% followed by 24.72% of neoplasms and 5.86% of the digestive system. 8However, a cross-sectional study performed in the interior of São Paulo resulted in 24.8% of cardiovascular diseases, followed by 13. 1% of neoplasms and 11.6% of gastrointestinal diseases. 9nother quantitative descriptive study conducted in Rio de Janeiro -RJ found a higher prevalence of cardiovascular diseases (32.55%), followed by respiratory tract diseases (27.90%). 1 Besides being the main cause of hospitalizations among the elderly, cardiovascular diseases are also considered the first cause of death in this population. 9 study that revised the guidelines of clinical practices for cardiovascular disease prevention revealed that the elderly over 75 years old have an increased risk for cardiovascular diseases. 19This statement was justified by the accentuated functional losses of the circulatory system, higher number of comorbidities, consequent increased functional losses acquired with advancing age and decreased adherence to treatments. 19hus, it can lead to more hospitalizations, readmissions, and deaths associated with the cardiovascular system. 19 retrospective study conducted in the USA evaluated the rates and predictors for hospitalization and readmission.20 This study found that 57.5% of the elderly patients were taking specific medications for each type of comorbidity.In a descriptive epidemiological study in Fortaleza, Ceará, which also evaluated the regular use of medication reported a similar rate of 53.3%.11 Drug treatment can play a decisive role in the life of the older people with diseases because, in addition to controlling the signs and symptoms, reduce the mortality and prevents future hospitalizations.11 In this research, the association between the use of regular medication specific to each comorbidity and the age group had a significant result, p = 0.008.A retrospective study of medical record analysis conducted in a health institution in Italy reported that 63.8% of all elderly patients were regularly using medications such as oral antidiabetic drugs. 16wever, the prevalence of use has decreased with age, since 24.9% of the elderly patients using medication were over 75 years old, 36.2% were between 65 and 75 years old, and 38.9% were under 65 years old.16 With advancing age, the elderly are more vulnerable to functional losses and comorbidities, such as chronic  In 230 (57.5%) of the 400 hospitalizations, the elderly patients were admitted for the first time in the institution, and 170 (42.5%) had readmissions in the year.Carrying chronic diseases and taking various medications are known to be risk factors for readmissions in the elderly population.20 A cross-sectional study found a readmission rate of 50.0% of the hospitalized elderly patients in 2015.22 However, a retrospective longitudinal cohort evaluation performed with diabetic elderly people beneficiaries of a health institution found 13.2% of readmission rate among elderly patients with Type 2 DM.20 Reduced readmission rates among patients As a diagnosis of hospitalization, cardiovascular disease was considered as one of the main risk factors for readmissions in the elderly population.20 A cross-sectional study conducted in northeastern Brazil indicated that the association between hospitalization diagnosis and clinical evolution was significant (p = 0.001), presenting cardiovascular diseases as the first cause of death.16 In this study, the association between hospitalization diagnosis and clinical evolution was also significant, p <0.001.However, the first cause that led patients to death was associated with the respiratory system, 33.3%, followed by cardiovascular, 14.9%.with DM in this study can be justified by the management of specific care for diabetics, which is typical of the institution.20 Therefore, knowledge of the profile of patients who are usually readmitted to health facilities enables better institutional and administrative management of health care for the elderly population.
A higher frequency one to 10 days of hospitalized elderly patients was observed, with a median of five.Data found in a cross-sectional study suggested the length of stay of more than seven days, with a median of three. 9Care of the multidisciplinary team influences the evolution during the hospitalization period of the elderly patient, promoting recovery and reducing the length of stay of the hospitalized patients. 9The shorter the Despite the natural deterioration of the organism associated with aging, knowing the institutional profile of the elderly patients contributes to clinical practice regarding planned care and the generation of health indicators that are essential for reducing the length of stay, morbidity and mortality rates and readmissions.
Future work for the scientific community can be developed for clinical and experimental comparison of cardiac, respiratory and endocrine diseases associated with readmissions, infections and physiological and clinical conditions of the elderly population, especially those over 75 years old. 11

Table 1 -
Socio-demographic profile and length of stay of hospitalized elderly patients in a philanthropic institution of Diamantina/MG-Brazil hospitalized elderly patients were 79.89%.

Table 2 -
Distribution of length of stay with hospitalization diagnoses, comorbidities and clinical evolution of hospitalized elderly patients in a philanthropic institution in Diamantina/MG-Brazil *p<0.05

Table 3 -
Distribution of the number of readmissions associated with the origin and comorbidities of patients in a philanthropic institution in Diamantina/MG-Brazil *p<0.05

Table 4 -
The association between gender, clinical evolution and marital status and the association between comorbidities, clinical evolution and home medication use of hospitalized patients in a philanthropic institution in Diamantina/MG-Brazil -demographic and clinical profile of older patients assisted in a philanthropic institution in the interior Minas Gerais *p<0.05 DOI: 10.5935/1415-2762.20190060Socio

Table 5 -
The association between age groups, comorbidities and hospitalization data (diagnosis of hospitalization, clinical evolution, and complications) of elderly patients in a philanthropic institution in Diamantina/MG-Brazil *p<0.05