Severity of disease in patients admitted for acute care to a general hospital: age and gender differences

Debates regarding unnecessary admissions and the benefit of hospitalization of older people for acute care lack data about severity of disease in older compared with younger patients, and comparison of gender. The objective was to assess the severity of illness upon admission in relation to age and gender, in a single-center, prospective observational study. Place was the Emergency room in a general community hospital in Oslo, Norway. Patients were consecutively admitted for acute care from October 1st to December 31st 2006.

The Acute Physiological Score (APS), which is part of the Acute Physiology and Chronic Health Evaluation (APACHE II) upon admission, age and gender, were main outcomes.

Of a total of 1736 patients admitted, 1565 (90.1%) were included in the study, 918 (58.7%) women and 600 (38.3%) aged 80+ years. Estimate (95% CI) for the age effect on the APS was 0.02 (0.016, 0.024), p<0.0001, which implies that the APS increases by 0.2 for every increase of one year, after adjusting for co-morbidities. The effect of female gender was -0.39 (-0.54, -0.24). Gender difference was highest among patients 80 years and older.

Older patients admitted for acute care have a higher severity of disease than younger ones. Males have more severe disease than females, particularly the oldest.