Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a "mission impossible"?
2008 (English)In: International Journal of Ageing and Later Life, ISSN 1652-8670, Vol. 3, no 2, 71-95 p.Article in journal (Refereed) Published
In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i) to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii) to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity), and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a) a literature review, (b) a register study, based on a unique population-based register of inpatient care in Sweden, and (c) a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and differens degrees of frailty.
Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. Vol. 3, no 2, 71-95 p.
priority setting, evidence-based guidelines, elderly, co-morbidity, cardiovascular disease, ageism
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-56241DOI: 10.3384/ijal.1652-8670.083271OAI: oai:DiVA.org:liu-56241DiVA: diva2:317628