Jino Joy, (2020) Outcome of Illness and Financial Burden of Influenza in Hospitalized Elderly Patients. Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND: Seasonal influenza in older adults often leads to hospitalization and multiple complications including secondary infections and acute worsening of background medical conditions. This leads to prolonged hospital stay and need for intensive care which in turn becomes a huge financial burden on the elderly and their caretakers. Understanding the factors that contribute to the clinical outcome will help in better patient care. PRIMARY OBJECTIVES: 1. To observe the clinical profile of seasonal influenza in hospitalized elderly with influenza. 2. To study the outcome of the illness and the various factors that affects the same. SECONDARY OBJECTIVES: 1. To study the mortality after one month of discharge and various factors that affects the same. 2. To study regarding the factors that lead to requirement of Intensive Care Unit treatment among older adults with influenza. 3. To estimate the financial burden of illness due to hospitalization. METHODS: We did a cross sectional observational study in a tertiary care hospital on the older adults (age > 60years) who were hospitalized with a diagnosis of Influenza, based on Swab RT-PCR positive for influenza. We looked at their baseline characteristics including socio economic profile, co-morbidities, and vaccination status. Patient’s social contacts one week prior to infection were looked upon. The clinical presentation, investigations on arrival, duration of illness and treatment received prior to presentation were also evaluated. Patients were followed up through their stay in hospital and the treatment modalities including medications; intensive care requirements, ventilatory support etc. were noted. Complications developed during the hospital stay were closely monitored. These parameters were analysed statistically with the outcome at discharge to look for associations. Patients were further followed up after one month and their status was recorded. The direct and indirect expenses incurred were also estimated. RESULTS: Between 1st April 2018 and 31st May 2019, 159 patients were recruited meeting the precalculated sample size. The median age of the study population was 68 (IQR 63 - 74). The leading influenza strain during the study period was H1N1 strain. The mortality rate at discharge was 11.3 per 100 patients and mortality at one month was 18.7. ICU admission rate was 25%. High qSOFA, CURB 65 and PSI were found to be predictors of mortality and requirement of ICU stay. Elevated liver enzymes, high creatinine levels and development of complications like secondary infections, acute kidney injury, acute coronary syndrome, delirium and need for ventilatory support increased risk of death in hospital and requirement of ICU Stay. The mean expenditure was calculated to be as high as Rs 1, 25,461 and median expenditure was Rs 68,045 (IQR 43319 to 124963). CONCLUSION: The elderly influenza patients present with atypical features and often develop multiple secondary complications during hospitalization. Early clinical suspicion and prompt treatment of influenza and its complications can improve the outcome of illness.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201726051 |
| Uncontrolled Keywords: | Illness, Financial Burden, Influenza, Hospitalized Elderly Patients. |
| Subjects: | MEDICAL > Geriatrics |
| Depositing User: | Subramani R |
| Date Deposited: | 03 Feb 2021 17:02 |
| Last Modified: | 03 Feb 2021 17:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13799 |
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