de Souza ER, Deslandes SF, Fortuna FFP, da Silva CFP. La morbilidad hospitalaria por violencia contra ancianos. Estudio de la atención de emergencia en dos hospitales públicos de Río de Janeiro. [Hospital morbidity due to violence against elders. Study of emergency care in two public hospitals ofRio de Janeiro.] Cuadernos Médico Sociales (Rosario,Argentina) 1999 November; 76:71-82.
Objectives: To analyze the morbidity of older people linked to violent causes in the public municipal hospitals of Rio de Janeiro, Brazil.
Design: Prospective cohort study, supplemented with contextual analysis. Descriptive epidemiology based on data collected in two hospitals: one situated in a high socioeconomic level area and the other in a poor area. The investigators chose patients arriving at the hospitals during one month who were considered typical in routine care. The study covered all patients who came to the hospital due to violent causes. The investigators followed each case from admission in the emergency room to discharge due to improvement, death, transfer to inpatient areas, or leaving without authorization. Quantitative data analysis complemented a qualitative investigation.
Theoretical framework: Based conceptually on the postulates of social medicine, the investigators conducted a contextual analysis of the problem of violence, the pressure which violence exerts in health services, the effects on the older population, and possible solutions.
Results: At the hospital located in the high socioeconomic level area, 204 older people entered due to violent causes in the month studied whereas 180 older people received services at the hospital located in the poor area . In both hospitals women were more affected (63.3%), and the largest frequency was in the age group of 70 years or more.Family income was low in almost 50% of the cases, although somewhat higher in the richer area. Many elders counted on the economic support of their families. In relation to medical care, the orthopedics specialty provided the most demanded services. The difference in care between the hospitals showed that the hospital in the poorer area manifested a larger participation of students as the only practitioner in the case (31.8% versus 15.2%), greater proportion of deaths (2.8% versus 1.6%), and more temporary or permanent sequellae (72.1% versus 61.2%).
Conclusions: Patients older than 70 years comprised a group vulnerable to violence. Differences between the hospitals care provided were related to the varying severity of the cases and a lack of medical personnel with experience at the hospital in the poorer area.
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