PAST MEDICAL msTORY

4.3 DISEASE PROCESS (ES) OF THE ELDERLY PATIENTS

4.3.3 PAST MEDICAL msTORY

4.3.3.1 HOSPITALISATION OF ELDERLY PATIENTS 4.3.3.1.1 Previous hospitalization of elderly patients

Findings of this study, revealed that 259 of the elderly patients (92.2%) in the sample population had been hospitalised previously, while only 22 (7.8%) had not been hospitalised. Of those patients that were hospitalised, the same patient may have been hospitalised on more than one occasion either for the same problem or for different problems.

4.3.3.1.2 Number of hospitalisations of elderly patients

Table 4.20 Number of hospitalisations of elderly patients Number of hospitalisation Frequency Percent

0 22 7.8%

1 84 29.9%

2 40 14.2%

3 18 6.4%

4 3 1.1%

5 4 1.4%

6 2 0.7%

7 1 0.4%

Surgical procedures 107 38.4%

TOTAL 281 100%

Table 4.20 displays the number ofhospitalisations of patients for medical reasons like

Drug rellded problems anwng geriatric out-patients at a public sector hospital: An intervention study 132

....

diabetes, uncontrolled hypertension, etc and those admitted for surgical procedures.

Surgical procedures: included operational procedures like a hysterectomy. Those patients that were admitted to hospital only for surgical procedures may have had more than one procedure done on different occasions. The following table lists the medical reasons for the patient's admission to hospital.

4.3.3.1.3 Reasons for hospital admissions

Table 4.21 Reasons for hospital admissions Reason for admission Frequencv Percent

Arrhythmia 11 3.9%

COAD 15 5.3%

CCF 25 8.9%

CRF 3 1.1%

CVA 17 6.0%

Diabetes 21 7.5%

Epilepsy 3 1.1%

Fracture I Dislocation 11 3.9%

Gastropathy 9 3.2%

Hypertension 16 5.7%

IHD 43 15.3%

MI 34 12.1%

Neuropathy 5 1.8%

Pulmonary embolism 1 0.4%

Transient ischaemic attack 1 0.4%

Pneumonia 10 4.0%

Hyperkalaemia 1 0.4%

Pernicious anaemia 1 0.4%

Parkinson disease 2 0.8%

Anaemia 3 1.2%

Cancer 2 0.8%

Cellulitis ₂ 0.8%

Claudication 1 0.4%

Constipation 2 0.8%

DVT 1 0.4%

Hyperkalemia 1 0.4%

Myasthenia Gravis 1 0.4%

Urethral stricture 1 0.4%

UTI 1 0.4%

Table 4.21 reflects the incidence of previous hospitalisations in the total sample population of 281 geriatric patients. One patient may have been admitted for different reasons at the same time or on different occasions. The greatest proportion of the patients (15.3%) were admitted for ischaemic heart disease (angina), followed by

Drug related problems among geriatric out-patients at a public sector hospital: An intervention study

12.1 % for myocardial infarction, 8.9% for congestive cardiac failure (CCF), 7.5% for diabetes and 5.7% for hypertension. This high incidence of hospital admissions is also a reflection that the patient's medical condition or symptoms are not completely controlled on their drug treatment. Unfortunately, the number of hospital admissions due to DRPs could not be established either from the patient or from the patient's medical notes and was beyond the scope of this study. Hospital admissions due to DRPs are a recommendation for a future study (Section 6.3).

4.3.3.2 PAST OPERATIONS OR SURGICAL PROCEDURES

Table 4.22 Past operations or surgical procedures in elderly patients Operations/sunrical procedures Frequency Percent

Bladder operation 8 2.8%

Cataract removal 37 13.2%

Transurethral resection of prostate and 12 4.3%

Or bladder (TURB)t

lIaemorroidectomy 14 5.0%

lIeart Bypass! Aortic valve replacement 12 4.3%

llip/ knee replacemenUrepair 8 2.90/0

lIysterectomy 70 24.90/0

IOL (Insertion of Lens) 5 l.8%

Neuronplasty" 3 1.1%

Sinus operation 1 0.4%

Aortic artery aneurysm 2 0.']0/0

Pacemaker Insertion 1 0.4%

Laminectomy 1 0.4%

Nephrectomy 1 0.4%

Gastrectomy 1 0.4%

Thyroidectomy 5 l.8%

Femoral Bypass 1 0.7%

Cholestectomy 8 2.90/0

lIernia repair 6 2.1%

Osteomy 1 0.4%

t

Transurethral resection of prostate and bladder (TURB) - procedure performed when patient has an enlarged prostate.

*Neuronplasty (circulatory problem, reconstructive surgery for damaged or severed peripheral nerves, post-CV A, aortic iliac disease)

Table 4.22 gives an indication of the operations and surgical procedures the elderly patients had undergone. The surgical procedures that the patients have undergone sometimes affect the patient's medical condition and drug therapy. For example, the 24.9% of the patient's (70) who had undergone a hysterectomy are candidates for

Drug related problems among geriatric out-patients at a public sector hospital: An intervention study

hormone replacement therapy (HRT). However, from results of the patient's pharmacotherapy (Table 4.33) only 15 patients were on estrogen replacement. The remaining 55 patients who need HRT but are not receiving it are at risk of CVD and osteoporosis.

Drug related problems among geriatric out-patients at a public sector hospital: An intervention study

4.3.3.3 SUMMARY OF THE PILOT STUDY, GENERAL

CHARACTERISTICS AND DISEASE PROCESS RESULTS

The discussions thus far were of the pilot study, general characteristics and disease process results. A sample size of 281 geriatric patients was determined as being statistically significant for this study. The mean age of the geriatric population was 73.0 ± 5.8 years (range 65 to 93) with the majority of the patients (41.6%) aged between 65 and 70 years. Majority of the patients were female (63.3%) and 49.1% of the patients were white in the total sample population. Results of the study indicated that 62.3%ofthe patients were retired and 36.7% were housewives.

Most of the patients (90.7%) did receive some form of education. However 16.0%

and 20.6% did have problems in reading and writing respectively. This illiteracy may have been one of the reasons for non-compliance with their drug treatment. Lack of caregiver support in 45.9% of the patients may also have affected compliance.

30.6% and 12.5% of the elderly patients indicated that they did consume alcohol and smoked cigarettes respectively. As was expected 62.3% of the elderly patients experienced sleeping difficulties.

The range of medical conditions in the elderly patients was from 1 to 9. The most common conditions were hypertension (64.8%), ischaemic heart disease (43.8%), musculoskeletal disorders (42.7%) and diabetes (29.2%). Some of the impairments or disabilities of the elderly patients were as follows: poor vision (82.9%), poor hearing (50.5%), poor mobility (59.1%) and poor speech (4.6%). Findings of this study revealed that 92.2% of the patients had been hospitalised previously with ischaemic heart disease (15.3 %) and myocardial infarct (12.1 %) being the most common medical reasons for hospital admission.

Drug reloted problems among geriatric out-patients at a public sector hospital: An intervention study