Determinants of recourse to hospital treatment in the elderly.

BACKGROUND: All over Europe, an increased use of public health services has been noticed, particularly referring to access and hospitalization among elderly in the emergency department (ED). METHODS: Prospective study at a university teaching hospital in Turin, northern Italy, recruiting subjects aged >65 years consecutively attending the medical ED during 1 month. Demography, functional and cognitive status, comorbidity, severity of acute critical illness, previous ED accesses and hospitalization, diagnosis and other relevant data for ED admission and hospitalization were considered. RESULTS: Data were collected for 1632 patients (average age 77.6 years), 89% of the 1834 older subjects who attended the ED during the study period (29.3% of the patients attending the ED). Six hundred and fifty older subjects were admitted to the hospital (62.2% of the hospital admissions). Severity of acute critical illness, presence of chronic obstructive pulmonary disease and heart failure, a high number of drugs being taken, functional dependence and advanced age were independently associated with hospital admission. One-third of the patients appeared to be frequent users of health services with more than two visits/admissions. Higher comorbidity, partial or complete functional dependence, chronic diseases (arrhythmia, pulmonary neoplasm, diseases of the large intestine) and politherapy were associated either with frequent use of the ED and multiple admissions. CONCLUSIONS: Elderly account for a high proportion of hospitalizations, mainly determined by critical health conditions, advanced age and functional dependence. Poor health conditions (high comorbidity and presence of chronic multi-organ diseases), functional dependence but not critical social factors were the main determinants of multiple hospital admissions.

Metabolic syndrome in older subjects: coincidence or clustering?

The prevalence of the metabolic syndrome (MS) increases with advancing age. However, aging per se is associated with increased prevalence of most of the abnormalities contributing to the MS. Whether MS in older people consistently identifies a true pathophysiological entity or a casual aggregation of aging-associated metabolic abnormalities, remains to be fully elucidated. In the present study, we aimed to evaluate whether in older subjects the aggregation of metabolic components of the MS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), is consistent with a single latent variable. Age, waist circumference, systolic and diastolic blood pressure, metabolic variables were determined in 152 older (>70 years), non-diabetic, healthy men. Cronbach alpha was used to assess the internal consistency of the components contributing to the MS. Structural equation modeling, using the Normed Fit Index (NFI), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), and the Tucker-Lewis Index (TLI) was used to assess the fit to a model with a single latent variable. The Cronbach alpha test showed low internal consistency among the metabolic variables (alpha=0.31). The calculated chi(2) values were 28.31 and 32.52 for model entering hypertension as dichotomous variable and for model entering blood pressure values, respectively, both expressing low fit to a model with a single latent variable. In both models, CFI (0.41 and 0.55), NFI (0.59 and 0.55), RMSEA (0.25 and 0.22) and TLI (-0.31 and -0.12) scores showed a low fit of the metabolic alterations to a single latent variable. These findings suggest caution in making diagnosis of MS at older ages, since metabolic and cardiovascular abnormalities being per se extremely common in elderly people, do not appear to cluster together under a single common factor.