Hospital São Rafael, Departamento de Neurologia, Instituto D'Or de Pesquisa e Educação, Salvador BA, Brazil.
Hospital São Rafael, Fundação Monte Tabor, Centro Ítalo-Brasileiro de Promoção Sanitária, Salvador BA, Brazil.
Arq Neuropsiquiatr. 2021 Jan;79(1):30-37. doi: 10.1590/0004-282X-anp-2020-0091.
Multimorbidity is common among adults and associated with socioeconomic deprivation, polypharmacy, poor quality of life, functional impairment, and mortality.
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.
We enrolled patients aged ≥60 years successively admitted to a tertiary medical center with NDs between January 1, 2009, and December 31, 2010.
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).
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.
多发病症在成年人中很常见，与社会经济贫困、多种药物治疗、生活质量差、功能障碍和死亡率有关。
确定患有神经疾病（NDs）的老年住院患者多发病症的频率，对与 NDs 相关的慢性合并症进行聚类分析，并确定多发病症与该人群的人口统计学数据、再入院、长住院时间（LOS）和医院死亡率之间的关系。
我们连续纳入了 2009 年 1 月 1 日至 2010 年 12 月 31 日在一家三级医疗中心因 NDs 住院的年龄≥60 岁的患者。
共有 798 名年龄≥60 岁的住院患者被诊断为 NDs（共 1154 种 NDs 和 2679 种合并症），其中女性占 435 例（54.51%）。92.61%（739 例）的患者存在多发病症，平均合并症为 3.88±1.67（中位数：4.0），范围为 2 至 10 种慢性病。患有癫痫、痴呆和运动障碍的患者慢性病聚类程度最高（≥5 种慢性病的患者比例超过 50%），其次是患有脑血管病和神经肌肉疾病的患者。多发病症与长 LOS（p<0.001）和再入院（p=0.039）有关，但与医院死亡率无关（p=0.999）。
多发病症在患有 NDs 的老年住院患者中较为常见，而且 NDs 与多种相关的慢性合并症关系密切。多发病症，而不是孤立的 NDs，与再入院和长 LOS 有关。这些结果支持为患有 NDs 的老年住院患者提供基于病房的、神经科医师主导的、跨学科的护理，以应对多发病症。
