Population ageing is a global demographic phenomenon driven by declining fertility and increasing life expectancy, with profound implications for healthcare systems worldwide. According to United Nations projections and national reports, the number of adults aged 60 years and above is rising sharply and is expected to increase substantially in coming decades, reflecting both biological and social determinants of longevity and dependency. ^1,2 In India, the older adult population has grown rapidly; according to the 2011 Census, there were approximately 104 million persons aged ≥60 years, representing 8.6% of the total population, and this share is projected to nearly double by mid-century as a result of demographic transition.³ The burden of age-related chronic illnesses, including cardiovascular diseases, diabetes, and respiratory and musculoskeletal disorders, has also escalated; large population surveys such as the Longitudinal Ageing Study in India (LASI) have reported that a significant proportion of older adults suffer from one or more chronic conditions, with multimorbidity becoming increasingly common with advancing age.⁴

Despite this growing health burden, specialized geriatric healthcare services in India remain underdeveloped, with most elderly patients managed in general medical wards without geriatric-specific care pathways.⁵ This gap is concerning because older inpatients typically present with multiple comorbidities, atypical clinical manifestations, functional decline, and greater susceptibility to complications such as delirium, hospital-acquired infections, and prolonged hospitalization.⁶ Therefore, this study was undertaken to comprehensively assess the clinical profile, presenting patterns, system-wise morbidity, burden of multimorbidity, and outcomes among hospitalized elderly patients, with the aim of studying the demographic and socio-economic profile of elderly inpatients, identifying the most common presenting symptoms and signs in this population and assessment of proportion comorbid conditions in these patients.

This was a cross-sectional study conducted in the all medical wards under Department of Medicine at Tertiary Care Center in Northeast India. The study duration for the study was the patients admitted during the period of 1 year, September 2024 to August 2025. We included representative sample of 100 elderly patients (age ≥65 years) admitted in medicine wards. Inclusion criteria for the study were age ≥65 years and admission to the medicine ward; while patients or their caretakers provided written informed consent were included as study participants. Data were collected using semi-structured validated proforma capturing demographics (age, sex, residence, education, socioeconomic status, marital status), lifestyle factors (smoking, alcohol, diet, physical activity), presenting symptoms, physical findings, and diagnoses by system. The analysis was done by MS Excel and CDC Epi Info 7.2.5.0 (year 2024) software. For descriptive statistics, mean and standard deviation were taken in consideration and results were observed at 5% significance. Prior permission was taken from the Institutional Ethics Committee from Tertiary Care Center. Participants were fully assured of the confidentiality and anonymity of the information provided by them. The descriptive statistics (mean±SD for age; frequency and percentage for categorical variables etc.) were computed. No financial assistance was sought and conflict of interest was declared as none. The study was permitted by IEC from Tertiary Care Center (vide 29/2026).

Demographic and Socioeconomic Profile. The mean patient age was 73.4 ± 7.3 years (range 65–91); 60% were 65–74, 30% were 75–84, and 10% were ≥85 years. Female patients predominated (57%). Most patients resided in rural areas (86%) and had low education (51% no formal schooling). A majority belonged to lower socioeconomic class (64%), were married (67%), and had poor dietary habits (63%). Smoking and alcohol use were reported in 38% of patients each. Over half were only moderately active physically. The average length of stay for patients in this hospital was 4.71 (SD – 1.86) days. Among all the patients, 23 patients needed to be shifted to ICU, while 2 patients needed surgical interventions. The number of deaths were 13 and 7 patients were referred to other setups for various reasons.

Presenting Symptoms. The constitutional complaints were common: easy fatigability (69%), fever (52%), weight loss (24%), nausea/vomiting (29%), and anorexia (10%). Neurological/neuropsychiatric symptoms included limb weakness (30%), altered sensorium (25%), headache (22%), seizures (10%), speech difficulty (16%), and transient loss of consciousness (2%). Cardiorespiratory symptoms included dyspnea (55%), cough (39%), chest pain (34%), palpitations (11%), pedal edema (21%), and hemoptysis (2%). Gastrointestinal complaints were vomiting (22%), abdominal pain (13%), abdominal distension (8%), altered bowel habits (8%), and jaundice (5%). Genitourinary symptoms were oliguria/anuria (23%), dysuria (4%), and urinary incontinence (2%).

System-wise Involvement. Many patients had multi-system presentations. In total, 86% had genitourinary system complaints, 71% had cardiorespiratory issues, 51% had gastrointestinal problems, 47% had neuropsychiatric symptoms, 45% had constitutional complaints, and 28% had musculoskeletal symptoms (e.g. joint or muscle pain) on admission. Table 3 shows the number of patients with each system involvement.

Table 1: System-wise Clinical Presentations+

Comorbid Conditions. Common coexisting diseases were hypertension (present in 50% of patients), anemia (26%), diabetes mellitus (20%), stroke or cerebrovascular disease (19%), and chronic kidney disease (16%). Other noted conditions included COPD (12%), pneumonia (12%), hypothyroidism (<3%), and osteoporosis (3%).

The present study evaluated 100 hospitalized elderly patients with a mean age of 73.4 ± 7.3 years, with the majority (60%) in the 65–74 year age group. This age distribution is comparable to the findings of Ambali et al. who reported that 65% of admitted geriatric patients belonged to the young-old category (60–74 years)7 and Prasad Vasanth et al., where young-old group (65–74 years) constituted 63.5% of admissions.8. Similarly, Difoesa et al. observed that 31.5% of their geriatric inpatients were in the 60–64 year group, representing the largest age segment9. Reddy et al. also noted clustering of admissions in the 65–74 year range (60%) 10. This consistent predominance of young-old admissions across studies suggests that early geriatric years are a critical period for hospitalization due to escalating chronic disease burden. Unlike several hospital-based studies that reported male predominance, the present study showed female predominance (57%). In contrast, Reddy et al. documented 66% male admissions10, and Difoesa et al. observed a nearly equal distribution but slight male excess (50.6%)9. However, Ambali et al. reported 60% female patients, aligning closely with our findings 7. The higher female proportion in certain regions may reflect longer female life expectancy and sociocultural care-seeking differences. A striking feature in the present study was the high proportion of rural residents (86%) and individuals from lower socioeconomic strata (64%). This contrasts with Patel et al., whose South Gujarat cohort had more mixed urban–rural representation, although they similarly reported high multimorbidity among economically vulnerable elderly11. Socioeconomic disadvantage is known to exacerbate nutritional deficits, poor access to preventive care, and late presentation. Presenting Symptoms Constitutional symptoms such as fatigue (69%) and fever (52%) were highly prevalent in our study. The mirrors the findings of Vasanth et al.8, who identified constitutional symptoms in 74% of elderly admissions, with easy fatigability being the most common presentation. Ambali et al. similarly highlighted constitutional symptoms as the most frequent category, with breathlessness (30%) and fever common7. Nonspecific presentations are characteristic of elderly admissions and often mask underlying systemic disease. Cardiorespiratory symptoms were prominent: dyspnea (55%), cough (39%), and chest pain (34%). This mirrors Reddy et al., who reported 60.5% respiratory system involvement, with COPD present in 37% of patients10. Difoesa et al. also found respiratory morbidity in 30.3% of admissions 9. Vasanth et al.8 also observed cardiorespiratory symptoms in 65.5% of elderly patientsThese consistent findings underscore the dominance of chronic respiratory and cardiac conditions in geriatric hospitalizations. Neurological manifestations such as limb weakness (30%) and altered sensorium (25%) were also common. Vasanth et al.8 found neurological diseases to be the most common system-wise morbidity (51%), while as limb weakness (30%) and altered sensorium (25%) were also frequent in present study. Difoesa et al. reported neurological system involvement in 42.3% of cases, largely due to stroke 9, while Reddy et al. noted neurological disorders in 26% of admissions10. Our findings therefore align with national trends showing high cerebrovascular morbidity among elderly inpatients. System-wise Morbidity Multi-system involvement was common in the present study, with cardiorespiratory (71%) and genitourinary (28%) presentations prominent. Patel et al. reported cardiovascular disease in 48%, respiratory disease in 42%, and renal disease in 40% of elderly admissions 11. Tiwari et al. similarly identified respiratory (27%) and cardiovascular (22.3%) systems as leading categories in a much larger cohort (n = 970) 12. Although percentages differ due to methodology and classification, the hierarchy of system involvement remains comparable. Comorbidity Pattern The present study found hypertension in 50%, diabetes in 20%, anemia in 26%, stroke in 19%, and chronic kidney disease in 16%. Hypertension remains the dominant comorbidity across studies. Reddy et al. reported hypertension in 49% of patients 10, while Difoesa et al. noted hypertension in 29.5% 9 and Vasanth P8 had similar findings. Tiwari et al. documented hypertension in 6% as a primary diagnosis but much higher when comorbidities were included 12. Diabetes prevalence in our study (20%) is lower than Reddy et al.10 (47%) but consistent with Difoesa et al.9 (9.9%) and Patel et al.11, where endocrine diseases formed a smaller yet significant proportion. Stroke prevalence (19%) in our cohort aligns closely with Difoesa et al.9. AA Swami et al 12 reported the socioeconomic burden of NCDs in patients, geriatric people will be more affected by the out of pocket expenditure on diseases like diabetes. where cerebrovascular accidents accounted for the majority of neurological admissions, and with Tiwari et al.13 who reported 6.1% CVA as a primary diagnosis but higher when comorbid. JP Baravakar et al.14 Also reported depression as a post MI sequelae in geriatric population, which highlights the psychiatric comorbidity highlighted by cardiovascular event in old age people. Multimorbidity Although not quantified numerically in our results table, the high burden of concurrent conditions parallels other studies where multimorbidity exceeded 80%. Reddy et al.10 reported 82.5% of patients had more than one condition, while Patel et al. 11 found 90% had multiple diagnoses. Vasanth et al.8, who reported an average of 2.79 ailments per person, rising to 4.23 in the oldest-old group. Many previous studies reported various morbidities in geriatric patients from both the genders and all occupations requiring customized and affordable patient care they also suggested overall geriatric care approach for complete geriatric wellness rather than just health care. 13-17 This confirms that geriatric admissions are typically complex, requiring integrated multidisciplinary care.

In this tertiary hospital study of geriatric inpatients, nonspecific constitutional complaints (especially easy fatigability and fever) were very common. Patients often had multi-system involvement, with genitourinary and cardiorespiratory systems most frequently affected. Hypertension, anemia, diabetes, and stroke were prevalent comorbidities. These findings highlight the need for holistic, multi-disciplinary care in hospitalized elderly and may guide resource allocation for geriatric care. Early recognition of these common presentations can improve management and outcomes.