Better primary care for elderly could reduce hospitalisation by 50%
31 March 2008
An efficient response in primary care would reduce hospitalisation of
people over 60 by more than 50%, for cases caused by three of the most
common illnesses in the older population: diabetic ketoacidosis,
digestive haemorrhage and chronic bronchitis.
This is the startling result of a study carried out by researchers
from the Department of Preventive Medicine and Public Health at the
University of Granada, Spain.
In Spain the percentage of the Spanish population that reaches an
elderly age has risen from 26% at the beginning of the 20th century to
86% today. The elderly population makes up between 40-45% of the
hospitalisations, occupies 40-50% of doctors working in primary care,
and is the recipient of more than 50% of the medicines prescribed in
The researchers interviewed all the family doctors from seven
different hospitals in Granada and asked them the main reasons for
hospitalisations in patients over 60 as well as to what extent these
hospitalisations, caused by the problems described above, could be
The interviewed professionals answered that a more efficient response
in primary healthcare would reduce in more than 50% the hospitalisations
caused by three pathologies: diabetic ketoacidosis, digestive
haemorrhage and chronic bronchitis. However, in patients suffering from
cancer and acute coronary syndrome enhanced primary care would only
reduce the hospitalisations by 25%.
The researchers analysed six health problems, three chronic diseases
(acute coronary syndrome, chronic bronchitis and diabetes) and three
acute ones (pneumonia, transient ischemic attack and digestive
haemorrhage) to find the connection between primary care effectiveness
and the prevention of hospitalisations caused by these health problems.
717 patients over 60 were taken for the study, with an average age of
75.65 years, 59.97% of whom were men.
Twice the risk
Each new chronic disease suffered by a patient means twice the risk
of hospitalisation by any of the six studied pathologies, which means
that anyone suffering five or more diseases would present a probability
of hospitalisation 61 times higher than a healthy person. Moreover, each
new medicine prescribed increases the risk of hospitalisation. Those
patients who have been taking five or more different medications for the
last six months have a 4.84 times increase in their risk of
hospitalisation for these pathologies.
In short, the number of pathologies suffered by individual as well as
past hospitalisations for causes different to those studied was
considered as a risk factor for hospitalisation, although more
significantly for severe cases. The amount of medicines consumed and the
number of visits to the hospital were related to a higher frequency of
hospitalisation, especially in chronic cases.
Part of the results from this study has been published in the journal
Atención Primaria. Further papers will be studied in specialist