Comparison of morbidity of elderly in August and November in Attica

George Theocharis,1 MD, Michael N. Mavros,2 MD, Evridiki K. Vouloumanou,2 MD,
George Peppas,1,2 MD, PhD, Spyridon G. Barbas,1 MD, Theodore Spiropoulos,1 MD,
Matthew E. Falagas,2,3,4 MD, MSc, DSc

1. SOS Doctors, Athens, Greece
2. Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
3. Department of Medicine, Henry Dunant Hospital, Athens, Greece
4. Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

Corresponding author:

Matthew Ε. Falagas, MD, MSc, DSc
Alfa Institute of Biomedical Sciences (AIBS),
9 Neapoleos Street, 151 23 Marousi, Athens, Greece
Tel: +30-694-61.10.000
Fax: +30-210-68.39.605
E-mail: [email protected]

Short title: Morbidity of elderly in August and November.
Funding: None
Conflict of interest: None
Word counts: abstract: 241, text: 2183
Number of Tables: 5
Number of figures: 1
Number of references: 17

ABSTRACT

Background:

In our clinical practice, we have experienced a consistent increase in the morbidity of elderly in Greece during August.

Methods:

We prospectively analyzed and compared the morbidity of elderly (≥75 years old) between August and November of the same year (2010), using data from the SOS Doctors (a network of physicians performing house call visits).

Results:

We analyzed data on 739 and 738 elderly patient house-calls in August and November, respectively. Overall, the most common diagnoses were cardiovascular (17.6%), musculoskeletal (10.7%), gastrointestinal (9.5%), respiratory (8.5%), renal/genitourinary (8.1%), and neurologic/psychiatric (7.9%). In August, patients were older (p<0.01), carried a heavier burden of disease (as inferred by specific types of comorbidity and associated medical conditions), were more frequently recommended emergent hospitalization (p<0.01) and had a worse outcome of primary illness (p<0.05). Mortality of elderly visited in August was significantly higher compared to November (5% versus 2%, p<0.01). The sole independent predictor of mortality was patient’s bedridden status [adjusted odds ratio (OR)=5.59, 95% confidence intervals (CI) 2.83-11.06, p<0.001]. The identified independent predictors of recommendation for emergent hospitalization were patient’s sedation [OR=2.88 (1.80, 4.59), p<0.001], fever [OR=2.55 (1.84, 3.54), p<0.001], heat stroke [OR=2.08 (1.19, 3.64), p=0.01], Alzheimer’s disease [OR=1.77 (1.15, 2.72), p=0.01], and bedridden status [OR=1.45 (1.07, 1.97), p<0.05].

Conclusion:

Morbidity and mortality of elderly patients was significantly higher in August compared to November, substantiating the informal term “Augustitis” for the Greek elderly. Large, prospective population-based studies are warranted to further enlighten this field.

Keywords:

older individuals, age, geriatrics, primary care, seasonality