Abdelmoula Leila, Tekaya Raoudha, Ben Hadj Yahia Chiraz, Chaabouni Lilia, Zouari Rafik
Service de rhumatologie, Hôpital Charles Nicolle, Tunis, Tunisie.
Tunis Med. 2008 Apr;86(4):350-4.
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 > or =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. Iatrogenic 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.
我国人均寿命的提高至少部分解释了住院患者中老年人比例的增加。
本研究旨在确定导致老年患者入住风湿科的主要疾病，建立其临床特征并评估其治疗质量。
对2003年1月至2004年12月期间在查尔斯·尼科尔医院风湿科住院的老年人（年龄≥65岁）进行回顾性病历审查。
在该期间入住我们住院部的831例患者中，86例年龄在65岁及以上，占总数的10%。平均年龄为71.2岁[65 - 88岁]。男女比例为1/3。平均有两种合并疾病史[0 - 5种]。以高血压（50%）和糖尿病（26.7%）为主。近1/3的老年人有手术史。仅19%的病例有胃肠道问题。住院的主要原因是诊断检查（77.6%）。其余患者因治疗调整入院。疾病平均已发展16个月（15天 - 15年）。平均住院时间为21.2天（4 - 60天）。所涉及的病理情况多样，以退行性风湿病（26.7%）为主，好发于腰椎；全身性疾病：18例（20.9%），其中类风湿关节炎13例；恶性骨病（18.7%）。49例患者（57%）同时存在至少两种风湿性疾病。在这类老年患者中，几乎一半病例（42.4%）的临床表现不典型。除了用于非风湿性疾病的药物外，我们的患者平均服用3.4种药物（1 - 8种）作为对症、辅助或病因治疗。74.4%的病例治疗依从性良好。14例患者（16.2%）发生医源性事件。68.9%的病例预后良好。我们的12例患者需要三级护理。一半患者（54%）在出院后1 - 2个月在我们的门诊得到控制，12例因同一疾病再次住院，8例死亡，19例失访。
老年住院患者的管理必须是多学科的。应考虑到这类人群的临床和治疗特殊性。预防仍然是提高生活质量以及降低社会和经济成本的最佳保障。
