INTRODUCTION
With the increase in life expectancy, the elderly population in Brazil has grown.
Therefore, the frequency of accidents with burns in this age group also increased
due to risk factors such as slowing of gait, cognitive difficulties, psychiatric disorders,
chronic comorbidities, and polypharmacy. These often-limiting factors contribute to
some restrictions that can favor the occurrence of functional, psychological, and
aesthetic sequelae that, consequently, directly influence the prognosis and increase
the mortality rate1.
In addition, it is important to note that burn injuries can occur due to chemical,
thermal, radioactive, and electrical agents. Most accidents involving burns occur
at home, being mostly preventable and facilitated by negligence in daily home activities2.
The growth of the elderly population also interferes with the increase in the need
for hospital medical care in this age group, as they remain hospitalized for longer,
presenting a worse prognosis, which results in increased mortality, data that are
in line with the current study2.
According to Padua et al.1, most cases of burns occur in low-income regions that probably do not have adequate
infrastructure that can help reduce the length of hospital stay and, consequently,
reduce the mortality rate.
OBJECTIVES
This study aims to analyze the mortality rate and the average hospital stay of elderly
patients (≥ 60 years) who are burns victims so that the appropriate public and community
health sectors can be held responsible for intervening adequately, quickly, and effectively.
METHODS
This is a cross-sectional and documental study with a quantitative approach, whose
epidemiological information on hospital morbidity and mortality and health indicators
from January 2010 to December 2019 were obtained through the Department of Informatics
of the Brazilian Public Health System (DATASUS - Departamento de Informática do Sistema Único de Saúde)3 Hospital Morbidity Declaration System.
Information on hospital morbidity and mortality was searched according to interest
in the results: Burns and Corrosion (Code ICD-10: T20-T32). For this group, the following
categories of analysis were specified: sex, age group, the average length of stay
(in days), mortality rate and place of residence.
The graphics of the figures were made using the Pages program (Apple)TM.
RESULTS
Figure 1 shows data on mortality from burns and corrosion in the elderly from 2010 to 2019,
totaling 9%. There was no significant change in the mortality rate in the elderly
in this time interval and in individuals younger than 60 years, who presented an overall
rate of 2.87% for the period studied.
Figure 1 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by year of processing.
Figure 1 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by year of processing.
Regarding gender, the mortality rate for women was 8.77% and 9.18% for men in the
period studied. Figure 2 shows inconsistent rates for men and women, showing no significant increase or decrease.
Figure 2 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by gender and
year of processing.
Figure 2 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by gender and
year of processing.
Figure 3 shows the mortality rate by age group for the period studied. In this time interval,
there was a 30.91% increase in the rate for the age group over 80 years old (growing
from 14.75% in 2010 to 19.31% in 2019). As for the age groups between 60 and 79 years
old, no significant variations were observed.
Figure 3 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by age group
and year of processing.
Figure 3 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by age group
and year of processing.
Regarding the distribution of reported cases, Figure 4 shows the mortality rate by region of the country by year of processing. The Southeast
Region had the highest mortality (11.21%), followed by the Northeast Region (9.55%),
South (7.68%), North (7.52%) and Midwest (4.03%). The North Region recorded the highest
mortality growth rate, going from 1.35% in 2010 to 15.48% in 2019 (growth of 1046.6%).
Figure 4 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by region and
year of processing.
Figure 4 - Mortality rate (%) from burns and corrosion in the elderly in Brazil by region and
year of processing.
Concerning the average hospital stay, the average hospital stay for Brazil as a whole
between 2010 and 2019 was 8.5 days. In this period, there was a reduction in the average
number of days (0.5 day decrease), from 8.6 days in 2010 to 8.1 days in 2019. Figure 5 and Table 1 show the evolution of the average hospital stay per year in Brazil during the period
studied and the average for Brazilian regions.
Figure 5 - Average hospital stay for burns and corrosion in the elderly in Brazil per year of
processing.
Figure 5 - Average hospital stay for burns and corrosion in the elderly in Brazil per year of
processing.
Table 1 - Average hospital stay (in days) for burns and corrosion in the elderly by regions
of Brazil for the period from 2010 to 2019.
|
Average hospital stay (in days) |
| North |
9.7 |
| Northeast |
7.6 |
| Southeast |
10.4 |
| South |
7.9 |
| Midwest |
5.7 |
Table 1 - Average hospital stay (in days) for burns and corrosion in the elderly by regions
of Brazil for the period from 2010 to 2019.
DISCUSSION
In Figure 1, it was observed that there was no significant variation in the mortality rate among
the elderly who suffered burns between 2010 and 2019.
Regarding the mortality rate in the studied period, in the elderly (9%) it was higher
than in the general population (2.87%), mainly considering that the inherent fragilities
of the elderly contribute to the fact that, regardless of the treatment implemented
for burns in the health service, the elderly are subject to a higher risk of mortality
concerning younger individuals than 60 years with burns, especially when other chronic
diseases are present, such as systemic arterial hypertension, diabetes, cardiovascular
diseases, arthritis, among other conditions4, since the presence of more comorbidities is closely related to a less favorable
outcome for the individual.
Furthermore, as seen in Figure 3, the age group of the elderly over 80 years old had a higher mortality rate than
the others. Due to the comorbidities mentioned above, the greater the age, the greater
the mortality of the elderly victim of burns. In this regard, the National Burn Repository
in the United States points out that, for an index of 50-59.9% of body surface burned,
the mortality rate of an older adult over 80 years of age is approximately 28 times
higher compared to an older adult aged between 60 and 69 years, as complications such
as urinary tract infection, pneumonia, cardiac arrest, respiratory failure, among
others, become more frequent during treatment with increasing age5.
Considering each older adult’s physical and mental illnesses, increasingly individualized
treatment should be implemented to control the patient’s hemostasis and prevent large
volume losses, which is difficult due to the individual’s previous comorbidities.
In addition, the aging of the skin itself, which culminates in lower regenerative
power and a decrease in the barrier function of the epidermis, makes it thinner and
more fragile, in addition to being more susceptible to injuries6.
Regarding gender, it was observed in Figure 2 that males have the highest mortality due to burns, but the difference for females
is slight. Both, when elderly, are subject to a higher risk of mortality from burns,
and the prominent place of occurrence is the domestic environment, especially the
kitchen, where they are prone to suffer scalds from overheated water, coffee and soups7.
Figure 4 shows the prevalence of the mortality rate in the states of the Southeast Region,
followed by the Northeast Region, then the South Region, then the Center-West and,
finally, the North Region. The predominance of mortality from burns in the Southeast
Region is due to the region’s higher socioeconomic and health development index compared
to others, resulting in a higher life expectancy for the elderly population and a
percentage increase in this age group8.
In this context, it is known that the elderly have become more active and have started
to live alone, regardless of the gradual and natural decrease in functional capacities,
limiting them physically and cognitively. Thus, this age group becomes more exposed
to the risk of accidents such as burns when performing domestic or work tasks.
There is also a progressive increase in mortality in the North region over the period
evaluated. Several factors influence this variation, such as the lack of information
and the sociocultural level of the population, for which, when living in poverty and
overcrowded environments, the risk of burns increases. Another important issue is
the existence of only one referral center for burns in the northern region, the Hospital Metropolitano de Urgência e Emergência (HMUE), located in Pará and which receives patients from both Pará and other states
in the region9. Thus, several patients are subject to a prolonged interval until specialized care,
increasing the risk of a negative outcome to the case, aggravated by the fact that
land transport is the most used to the detriment of aeromedical support.
Furthermore, the mortality rate of each region is closely related to the capacity
and infrastructure to reduce the occurrence rates and severity of burns10.
Finally, when analyzing the data presented in Figure 5, it is noted that there is no relevant variation in the average hospital stay in
the evaluated period, as described when evaluating the mortality rate. This data agrees
with the literature, which demonstrates that the longer the average length of stay
of the elderly in hospitals, the higher their mortality rate11.
One of the observations described is that patients who suffered burns need to undergo
wound debridement, which reduces the risk of infection and, consequently, the length
of hospital stay. In addition, it is important to emphasize that a longer hospital
stay increases the risk of contracting an infection resulting from in-hospital exposure.
This can be quite harmful, especially for the elderly patient, who, due to changes
in aging, the greater presence of comorbidities, and polypharmacy, among other factors,
becomes more vulnerable to a negative evolution.
CONCLUSION
Given this, it is possible to prove a high mortality rate from burns in the elderly,
becoming more expressive as the age group ages. In addition, it is possible to determine
the relevance of the hospitalization period for the elderly population concerning
the positive outcome of burn conditions. This reflection is supported by the data
that an adequate conduct reduces the period related to hospitalization, reducing,
in turn, the exposure to pathogens related to the hospital environment.
In this way, the importance of particularization of treatment and adequate preparation
of professionals involved in the multidisciplinary care of the elderly is noted to
promote more positive resolutions in these patients’ conditions.
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1. Universidade de Fortaleza, Curso de Medicina, Fortaleza, CE, Brazil
Corresponding author: Arthur Antunes Coimbra Pinheiro Pacífico, Rua Mariana Furtado Leite, 1250 - apto 1201 - torre 1, Eng. Luciano Cavalcante,
Fortaleza, CE, Brazil Zip Code: 60811-030, E-mail: arthurcoimbra@edu.unifor.br
Article received: April 14, 2021.
Article accepted: December 13, 2021.
Conflicts of interest: none.
