Physiological and functional status of older people discharged from hospital with ill-defined conditions

Abstract

This study was carried out in response to the policy attention directed at older people discharged from hospital with ill-defined conditions, or signs and symptoms related disease. In England there has been an increase in incidence of this type of hospital admission and policy suggests that patients with these codes have fewer medical/physiological and more ‘social’ conditions that could be better managed in community settings. Currently however, this population has not been characterised. Description of the functional and physiological status of these patients is essential for the planning of future health and social care services.

Patients with ill-defined conditions were described via a cross-sectional study of 80 patients aged over 70 years admitted to hospital with collapse/falls. Number of chronic diseases and
prescribed medications were obtained from the medical records. Routine blood tests were taken and serum cytokine concentrations (IL-1?, IL-6, TNF-?, IFN-?) were measured.
Deprivation score, functional status, depression and the prevalence of frailty were ascertained.

35 patients received ill-defined condition codes, 45 received other codes. Patients with ‘illdefined conditions’ had normal routine blood results but very high serum concentrations of
pro-inflammatory cytokines which did not correlate with number of chronic diseases indicating considerable medical problems. As the policy had suggested, they also had prevalent functional impairment (65.7%), high rates of frailty (77.1%) and pre-frailty (14.3%), and depression (42.9%). Patients with ill-defined conditions had poor outcomes evident in the high readmission (60%) and mortality (20%) rates. Patients were hospitalised for a
statistically significantly shorter period than patients with other codes (p<.05) and functional limitations and depression were associated with a longer length of stay. Increasing deprivation and TNF-? concentration were associated with an increase in the odds of an illdefined condition diagnosis at discharge.

The association between functional limitations, frailty, chronic disease and depression add considerable complexity to the health of older people with ill-defined conditions. However,
the prevalence of multiple morbidity, high serum concentrations of inflammatory markers and poor outcomes indicate that they also have considerable medical problems that may be largely unmet. These medical problems may result from chronic disease symptom crises and manifest as geriatric conditions for which there are no appropriate International Classification of Diseases (ICD-10) codes. The results of this study indicate a need for reevaluation of the ICD-10 system to incorporate the health problems faced by older people and further research into the effect of a more comprehensive community-based chronic
disease management that aims to enable frail older people to maintain health and independence at home and prevent readmission in patients with ill-defined conditions.

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Identifiers

ORCID for Katherine J. Hunt: orcid.org/0000-0002-6173-7319

ORCID for Bronagh Walsh: orcid.org/0000-0003-1008-0545

ORCID for Helen C. Roberts: orcid.org/0000-0002-5291-1880

ORCID for David Voegeli: orcid.org/0000-0003-3457-7177

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