A single centre retrospective study to analyze and compare mortality amongst geriatric and non-geriatric population presenting to a tertiary care hospital in Delhi

Introduction: India is a country currently undergoing a phase of demographic transition. Increased fertility rate and decreased mortality rate due to advancing health care facilities have contributed to the aging population. The geriatric age group is vulnerable period of life and has health problems and related morbidity and mortality which are very different from other age groups. The present study was conducted to compare and analyze the causes of mortality among patients of geriatric and non geriatric age group admitted to medical emergency in a Government run tertiary level teaching hospital in New Delhi. Materials and Methods: The data for all the patients admitted in the medical emergency department from January 2008 to December 2008 were obtained from Medical Records Department. The age of 65 was used as a demarcation between geriatric and non – geriatric groups for the purpose of study. Total number of patients who died from different causes were noted and sub-classified according to the cause of mortality. The percentage mortality due to different causes was calculated for both age groups and compared and analyzed. Results: The study revealed that a total of 10,711 patients were admitted to the medical emergency of which 2035 were in geriatric group and 8676 were in non geriatric group. The mortality rate in geriatric and non geriatric population was 14.3% and 7.65% respectively which was significantly higher in geriatric population statistically. CAD and COPD were the commonest disease responsible for mortality among geriatric patients while the leading cause for mortality among non geriatric group was infectious disease. Discussion: The geriatric population because of its widespread economic, social and health care implications needs utmost care to decrease associate morbidity and mortality and to improve the quality of life. Geriatrics as a separate branch in not too much developed and much needs to be done in this aspect to improve the health care delivery.

Keywords: Geriatric, mortality, non-geriatric

India is a country currently undergoing a phase of demographic transition. According to the 1961 Census of India, 5.6% of the Indian population (2.47 million persons) was aged more than 60 and according to 2001 it increased by 1.9% in four decades reaching up to 7.5% (7.66 million persons) of the population. ^[1] It is projected that if current trends in mortality and fertility rate were to continue, the population will increase to 12.4% (17.32 million persons) in 2026 in this age group. ^[1] In simplified terms every one in eight person will be above age group of 60. Also, according to census of 1991 the population of elderly above 65 years was 4.1% which rose to 4.77% in 2001. ^[2],[3] Increased fertility rate and decreased mortality rate due to advancing health care facilities have contributed to the aging population. This increase in age has lead to emergence of separate branches of Gerontology, which is study of aging and Geriatrics, which is social and health care of the elderly. In different demographics, different criteria have been used to define geriatric age group. Some use 60 years as cut-off for geriatric age group while few others have used 65 as cut-off for the same. ^[4] American National Institute for aging divides the geriatric group into three sub-groups: Young-old (65-74 years); older-old (75-84); and oldest-old (more than 85 years of age). ^[4]

The geriatric age group is vulnerable period of life. This increasing age of population has widespread health care, economic and socio-cultural implications. People belonging to different age groups have relatively different health issues. The elderly people have health problems and related morbidity and mortality which are very different from other age groups. The present study was conducted to compare and analyze the causes of mortality among patients of geriatric and non geriatric age group admitted to medical emergency in a Government run tertiary level teaching hospital in New Delhi.

This single center retrospective study was conducted in a tertiary care center in New Delhi for the period from January to December 2008. The data for all the patients admitted in the medical emergency department during the study period were obtained from MRD (Medical Records Department) and included in the study. The age of 65 was used as a demarcation between geriatric and non-geriatric groups for the purpose of study. The patients were divided into two groups based on their age – geriatrics group (patients above 65 years) and non-geriatric group (patients from 12-65 years of age). Among these, total number of patients who died from different causes were noted and sub-classified into different sub-groups according to the cause of mortality. The percentage mortality due to different causes was calculated for both age groups and compared and analyzed. Chi-square significance test was used to check for any significant difference in mortality rate between geriatrics and non geriatrics patients admitted in medicine emergency during the study period.

The study revealed that a total of 10,711 patients were admitted to the medical emergency during the study period from January 2008 to December 2008. Of the total, 2035 (19%) were in geriatric age group (> 65 years) and the rest 8676 (81%) were in non geriatric age group (12 – 65 years). The average number of patients admitted per month among geriatric group was 169.58 compared to average of 723 non-geriatric patients admitted per month. The total number of deaths among all patients admitted in medical emergency during study group was 954 with a mortality rate of 8.9%. The total number of deaths in the geriatric age group was 291 (14.3%) whereas number of deaths in the non geriatric group was 663 (7.65%). The mortality rate in geriatric population was significantly higher than non geriatric population statistically, with values of chi-square of 89.24. It was statistically significant to p < .0001. The relative risk of mortality in a geriatric patient admitted to medical emergency as compared to non geriatric patient was 1.871 with 95% confidence interval ranging from 1.645 to 2.129.

The comparison of various causes responsible for mortality revealed that coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) were the commonest disease responsible for mortality among geriatric patients, being responsible for 98 (33.67%) and 72 (24.74%) deaths respectively. Other significant causes were infectious causes, including tuberculosis (58 deaths) and miscellaneous (32 deaths). The leading cause for mortality among non geriatric group was infectious disease, including tuberculosis, responsible for 225 deaths (32.57%); followed by cardiac illness responsible for 165 deaths, including CAD (133 deaths), rheumatic heart disease (20 deaths) and cardiomyopathy and myocarditis (12 deaths). Other causes of mortality among both groups are listed in the [Table 1].

CAD and COPD were two most common diseases responsible for mortality in elderly and infectious and cardiac causes were the most common causes in non-geriatric population. These results were comparable to previous similar studies done. Mortality in geriatric population was significantly greater than non-geriatric population. Age related physiologic changes in elderly are highly responsible for this. Decreased self care and social neglect also play a significant role in this.

According to statistics by Government of India, most common cause of elderly mortality was cardiovascular disorders, accounting for one-third cases of elderly mortality. ^[5] A study analyzing the morbidity pattern in elderly revealed that hearing impairment followed by visual impairment were most common causes of morbidity in elderly population in India. ^[6] A study conducted in Delhi also revealed that problems related to vision and hearing were the most common cause of morbidity followed by backache. ^[7]

The geriatric population because of its widespread economic, social and health care implications needs utmost care to decrease associate morbidity and mortality and to improve the quality of life. Geriatrics as a separate branch in not too much developed and much needs to be done in this aspect to improve the health care delivery. Though separate geriatric outpatient department (OPD) services are provided by many tertiary care centers, geriatric health care at primary and secondary level needs to be strengthened. Also, various screening guidelines recommended for elderly needs to be strictly implemented in order to reduce the morbidity and mortality associated with non-communicable diseases. Elderly patients, on their every possible visit to physician, need to be educated regarding the importance of primary prevention and importance of screening guidelines and tests in that direction. It could help reduce the burden of disease on elderly population. Special importance needs to be given to the necessity of social support and counseling to the elderly.

A limitation of the study is that it is only a single center study. The importance of this study lies in the fact that, to the best of our knowledge, this is the first study in a tertiary care center in India comparing mortality among geriatric and non-geriatric population. Whereas, earlier studies in India have used age of 60 as cut-off for geriatric population, we have used age of 65 as cut-off as used in most developed countries.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.105142

[Table 1]