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Vol. 52, No. 2, 2006
Issue release date: February 2006
Section title: Clinical Section
Gerontology 2006;52:92–98
(DOI:10.1159/000090954)

Underappreciated Predictors for Postdischarge Mortality in Acute Hospitalized Oldest-Old Patients

Iwata M. · Kuzuya M. · Kitagawa Y. · Suzuki Y. · Iguchi A.
aDepartment of Geriatrics, Nagoya University Graduate School of Medicine, and bEmergency Department, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan

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Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: 5/2/2005
Accepted: 9/5/2005
Published online: 2/28/2006

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 2

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER

Abstract

Background: Although oldest-old, those aged 85 years and older, patients are the fastest growing segment, clinical evidences regarding the acute care of oldest-old patients are still lacking. Because acute medical conditions requiring emergent hospitalization is frequently followed by high rate of progressive physical decline and increased mortality after discharge in oldest-old patients, prognostic information collected during hospitalization can provide the basis for discussion about the goals of care and therapy. The aim of our study was to identify predictive factors for postdischarge mortality in oldest-old patients. Methods: The study included 403 oldest-old patients discharged from the acute care setting of a general hospital, who were followed-up for 1 year. Predictive values of the patients’ characteristics collected during their hospitalization for 1-year mortality were identified utilizing Cox proportional hazard regression analysis. Results: During 1-year follow-up, 104 patients (25.8%) died. The variables independently associated with 1-year mortality in multivariate analysis were the Charlson Comorbidity Index equal or greater than 2 [HR (hazard ratio) 4.71, 95%CI (confidence interval) 1.09–20.42], six or more prescribed medications at discharge (HR 3.12, 95% CI 1.39–6.99), benzodiazepines use (HR 1.64, 95% CI 1.04–2.60), nonsteroidal anti-inflammatory drugs use (HR 1.70, 95% CI 1.10–2.63), albumin less than or equaling 3.4 g/dl (HR 2.16, 95% CI 1.13–4.14), hemoglobin 10–12 g/dl (HR 2.32, 95% CI 1.22–3.56), hemoglobin less than 10 g/dl (HR 2.67, 95% CI 1.43–4.95), the presence of pressure sores (HR 1.84, 95% CI 1.14–2.97), and a history of delirium (HR 2.24, 95% CI 1.32–3.79). Functional impairment assessed by the Katz Index was only weakly associated with mortality (HR 1.24, 95% CI 0.53–2.91). Conclusion: Although often underappreciated, polypharmacy, particular medication use, anemia, the presence of pressure sores, and a history of delirium were important predictors for postdischarge mortality in oldest-old patients.


  

Author Contacts

Mitsunaga Iwata, MD
Department of Geriatrics, Nagoya University Graduate School of Medicine
65 Tsuruma-cho, Showa-ku
Nagoya, Aichi, 466-8550 (Japan)
Tel. +81 52 744 2364, Fax +81 52 744 2371, E-Mail iwatam@quartz.ocn.ne.jp

  

Article Information

Received: May 2, 2005
Accepted: September 5, 2005
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 2, Number of References : 35

  

Publication Details

Gerontology (International Journal of Experimental, Clinical and Behavioural Gerontology)

Vol. 52, No. 2, Year 2006 (Cover Date: February 2006)

Journal Editor: Meier-Ruge, W. (Basel)
ISSN: 0304–324X (print), 1423–0003 (Online)

For additional information: http://www.karger.com/GER


Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: 5/2/2005
Accepted: 9/5/2005
Published online: 2/28/2006

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 2

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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