Trends of the characteristics and appropriateness of admissions to acute geriatric and medical wards in Italy from 1988 through 1993

Recent modifications in the health care system in Italy reduced the number of inpatient care beds and limited the access to outpatient services while the proportion of older persons increased. To assess the burden of these changes on hospital care the characteristics of admissions to 35 acute geriatric wards and 31 internal medicine wards in Italy were studied between 1988 and 1993. All patients admitted during 4 months in 1988, 1 month in 1991 and 4 months in 1993 were enrolled in the study. The appropriateness of admission was assessed by means of the Appropriateness Evaluation Protocol criteria. The Charlson comorbidity index score was used to quantify comorbidity. Between 1988 and 1993, 18,790 patients were studied. The mean age increased from 67.9 ± 0.2 to 71.7 ± 0.2 years (p < 0.0001), the mean number of drugs taken during hospital stay increased from 5.2 ± 0.0 to 5.5 ± 0.0 drugs (p < 0.0001), the mean Charlson comorbidity index score increased from 1.33 ± 0.02 to 1.50 ± 0.03 (p < 0.0001) and the mean length of stay decreased from 17.6 ± 0.2 to 16.1 ± 0.2 days (p < 0.0001). The rate of appropriate admissions increased from 68.6% to 85.5% (p < 0.0001). Consistent results were found when the data were stratified according to gender and type of ward. It was concluded that in Italy, concurrently to an increased load of hospital care, inappropriate admissions diminished over time. These data show that the need for geriatric care is increasing.Abbreviations ATC anatomical therapeutic and chemical codes - GIFA Gruppo Italiano di Farmacovigilanza nell'Anziano — Italian Group of Pharmacoepidemiology in the Elderly The GIFA investigators are listed in the Appendix.     

Temporal patterns in air pollution and hospital admissions.

A 6-year data set of daily counts of admissions to 79 acute care hospitals in Southern Ontario was analyzed in relation to concurrent measurements of air pollution and weather pooled over the same regions, using progressively more sophisticated statistical techniques. The diagnoses studied included a group of respiratory causes and two control diagnoses: accidents and gastrointestinal causes. The 6-year period (1979-1985) was subdivided into six 2-month "seasons" and the area of study was divided into three subregions. Bivariate correlations were found to be significant more often than expected due to chance for all three admissions variables, but accounting for the temporal variation within the 60-day seasons greatly reduced the significance of the control diagnoses. Twenty-four-hour averages for air quality were found to yield more significant associations than peak hourly concentrations. July-August was the only period not having important within-season temporal trends and also had the lowest daily counts for respiratory admissions. Based on a model which accounted for serial correlation, SO2, ozone, and sulfate aerosol were found to be significant predictors of respiratory admissions during July-August. Using cumulative lags increased the magnitude of the estimated response to about 20% of summer respiratory admissions, but no consistent relationships were found which could identify the "responsible" pollutant(s) with certainty. Average pollutant concentrations were generally within U.S. ambient standards.     

Major trauma in geriatric patients.

Contemporary trauma to the elderly, its severity and associated mortality and morbidity in 111 United States and Canadian trauma centers are described. Three-thousand eight-hundred thirty-three (3,833) trauma patients age 65 years or older are compared to 42,944 injured patients under age 65. Although both groups had equivalent measures of injury severity, the older group had higher case fatality and complication rates and longer hospital stays. The results raise important questions regarding the triage, acute care, accurate prediction of outcome, and hospital reimbursement for the elderly injured patient, with implications for care evaluation, quality assurance, and the long-term viability of trauma centers and systems of care.     

Hospital admissions for abdominal pain in childhood.

From January to March 1980, a consecutive sample of 50 children admitted to hospital with acute abdominal pain provisionally diagnosed as appendicitis but who recovered spontaneously without a specific physical diagnosis was studied. The instruments used were a standardized parental interview and Rutter A(2) and B(2) questionnaires which are designed as screening devices to explore levels of emotional adjustment in children. A comparison was made with 43 children (controls) matched for sex and age from the same schools. Forty children suffering from acute appendicitis were studied in the same way. A significantly increased number of children in the nonspecific group obtained abnormal scores on the Rutter Scales compared with the control group (P less than 0.025). An unexpectedly large number (31%) of boys suffering from acute appendicitis obtained abnormal scores on the Rutter Scales. Postal follow up three months following discharge from hospital indicated that 8 (16%) of the nonspecific group were incapacitated to the extent of missing school. During the study, 15 children had a normal appendix removed at operation. Seven of them showed a significant degree of maladjustment.     

Chromosome mutations and pH disturbances.

Chromosomal anomalies, namely hypodiploidies, hyperdiploidies, and endoreduplications, developed in nearly 25% of metaphase plates of replicating human lymphocytes exposed in vitro to either acid (6.5 to 6.9) or alkaline (8.4 to 8.8) pH equilibriums. The G group was most susceptible to aneuploid formation. Mammalian mutations may develop as the result of a pH disturbance during cleavage of the fertilized zygote.     

Interface between geriatric and general medicine.

Information about their practice has been obtained from 652 consultant physicians in geriatric medicine representing 203 (78%) of the 259 health districts in the United Kingdom (UK). Joint appointments in general and geriatric medicine are held by 19.6%. Admissions policies included admissions selected by suitability for the department (58%) or on an age-related basis (37%)--the most common cut-off age being 75 years. In only a minority, however, were all medical patients above the designated age accepted. The policy generally applied only as long as empty geriatric beds were available. Integrated service (admitting geriatric and internal medicine patients of all ages to a common pool of beds) was practised in 5% of districts. Only one provided long-term care alone. Specialist interests within or in addition to geriatrics were reported by 26% of whole time and 48% of joint appointees. 'Pure' geriatrics remains the most popular form of practice.     

Fluid and electrolyte disorders. Water

It is very rare for disturbances of water balance to occur as isolated phenomena. More commonly, mixed electrolyte abnormalities present. However, to permit the logical application of therapy an understanding of basic water balance in health and disease is essential.     

Fluid and electrolyte disorders. Calcium

Parathyroid hormone, 1,25-dihydroxyvitamin D, and calcitonin are the three primary calcium-regulating hormones. Physiological changes in these occur throughout normal life but it is when levels remain excessively high or low, or when their target organs are diseased, that hypocalcaemia or hypercalcaemia may develop.