Journal Mobile Options
Table of Contents
Vol. 52, No. 2, 2006
Issue release date: February 2006

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

Iwata M. · Kuzuya M. · Kitagawa Y. · Suzuki Y. · Iguchi A.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

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.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
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.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Winograd CH: Targeting strategies: an overview of criteria and outcomes. J Am Geriatr Soc 1991;39:S25–S35.
  2. Lynn J, Teno JM, Harrell FE Jr: Accurate prognostication of death: opportunities and challenges for clinicians. West J Med 1995;163:250–257.
  3. Ponzetto M, Maero B, Maina P, Rosato R, Ciccone G, Merletti F, Rubenstein LZ, Fabris F: Risk factors for early and late mortality in hospitalized older patients: the continuing importance of functional status. J Gerontol A Biol Sci Med Sci 2003;58:1049–1054.
  4. Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE: Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001;285:2987–2994.
  5. Alarcón T, Barcena A, Gonzalez-Montalvo JI, Penalosa C, Salgado A: Factors predictive of outcome on admission to an acute geriatric ward. Age Ageing 1999;28:429–432.
  6. Ponzetto M, Zanocchi M, Maero B, Giona E, Francisetti F, Nicola E, Fabris F: Post-hospitalization mortality in the elderly. Arch Gerontol Geriatr 2003;36:83–91.
  7. Minicuci N, Maggi S, Noale M, Trabucchi M, Spolaore P, Crepaldi G; VELCA Group: Predicting mortality in older patients. The VELCA Study. Aging Clin Exp Res 2003;15:328–335.
  8. Narain P, Rubenstein LZ, Wieland GD, Rosbrook B, Strome LS, Pietruszka F, Morley JE: Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc 1988;36:775–783.
  9. Teno JM, Harrell FE Jr, Knaus W, Phillips RS, Wu AW, Connors A Jr, Wenger NS, Wagner D, Galanos A, Desbiens NA, Lynn J: Prediction of survival for older hospitalized patients: the HELP survival model. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 2000;48:S16–S24.
  10. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J: Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998;279:1187–1193.
  11. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS: Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 1997;12:203–208.
  12. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY: Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 2003;29:2137–2143.
  13. Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC, Ren XS, Lee A, Qian SX, Miller DR, Spiro A 3rd, Selim BJ, Kazis LE: The health status of elderly veteran enrollees in the Veterans Health Administration. J Am Geriatr Soc 2004;52:1271–1276.
  14. Goebeler S, Jylha M, Hervonen A: Medical history, cognitive status and mobility at the age of 90. A population-based study in Tampere, Finland. Aging Clin Exp Res 2003;15:154–161.
  15. Katz S, Ford AB, Moskowittz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914–919.
  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
  17. Task force on DSM-IV: Diagnostic and Statistical Manual of Mental Disorders DSM-IV, ed 4. Washington, DC, American Psychiatric Association, 1994.
  18. Librero J, Peiro S, Ordinana R: Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol 1999;52:171–179.
  19. Campbell SE, Seymour DG, Primorose WR; ACMEPLUS Project: A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing 2004;33:110–115.
  20. Atkin PA, Veitch PC, Veitch EM, Ogle SJ: The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging 1999;14:141–152.
  21. Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, Benser M, Bates DW: Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001;161:1629–1634.
  22. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH: Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716–2724.
  23. Tamblyn R, Abrahamowicz M, Berger R, McLeod P, Bartlett G: A 5-year prospective assessment of the risk associated with individual benzodiazepines and doses in new elderly users. J Am Geriatr Soc 2005;53:233–241.
  24. O’Keeffe S, Lavan J: The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997;45:174–178.
  25. Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK: Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 1994;42:809–815.
  26. Francis J, Martin D, Kapoor WN: A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097–1101.
  27. Cole M, Primeau F: Prognosis of delirium in elderly hospital patients. CMAJ 1993;149:41–46.
  28. Francis J, Kapoor WN: Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 1992;40:601–606.
  29. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E: Delirium predicts 12-month mortality. Arch Intern Med 2002;162:457–463.
  30. Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS: Prognostic significance of delirium in frail older people. Dement Geriatr Cogn Disord 2005;19:158–163.
  31. Rockwood K, Cosway S, Carver D, Jarrett P, Stadnyk K, Fisk J: The risk of dementia and death after delirium. Age Ageing 1999;28:551–556.
  32. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS: The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord 2003;16:156–162.
  33. Hung LC, Liu CC, Kuo HW: Risk factors of mortality among the home-based disabled patients in central Taiwan. Arch Gerontol Geriatr 2002;35:283–292.
  34. Corti MC, Guralnik JM, Salive ME, Sorkin JD: Serum albumin level and physical disability as predictors of mortality in older persons. JAMA 1994;272:1036–1042.
  35. Izaks GJ, Westendorp RG, Knook DL: The definition of anemia in older persons. JAMA 1999;281:1714–1717.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50