Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain

Barba, Raquel; Martínez, Javier; Zapatero, Antonio; Plaza, Susana; Losa, Juan Emilio; Canora, Jesús; Pérez, Alejandro; Casasola, G. García de

doi:10.1016/j.ejim.2010.11.001

Cited by 55 publications

(37 citation statements)

References 15 publications

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“…The association between co-morbidity and survival was also found previously in a study on 1,567,659 admissions [21], but in contrast to our study data on functional status was lacking.…”

Section: Discussionsupporting

confidence: 79%

Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

et al. 2012

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BackgroundFunctional decline is associated with increased risk of mortality in geriatric patients. Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission was studied as a predictor of survival in older patients admitted to an acute geriatric unit.MethodsAll first admissions of patients with age >65 years between January 1st 2005 and December 31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved from the hospital patient administrative system, and data on survival until September 6th 2010 were retrieved from the Civil Personal Registry. Co-morbidity was measured with Charlson Co-morbidity Index (CCI). Patients were followed until death or end of study.Results5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age 81.8 (6.8) and 83.9 (7.0) years respectively. The median [IQR] length of stay was 8 days, the median follow up [IQR] 1.4 [0.3; 2.8] years and in hospital mortality 8.2%. Mortality was greater in men than in women with median survival (95%-CI) 1.3 (1.2 -1.5) years and 2.2 (2.1-2.4) years respectively (p < 0.001). The median survivals (95%-CI) stratified on BI groups in men (n = 1,653) and women (n = 2,874) respectively were: BI 80-100: 2.6 (1.9-3.1) years and 4.5 (3.9-5.4) years; BI 50-79: 1.7 (1.5-2.1) years and 3.1 (2.7-3.5) years; BI 25-49: 1.5 (1.3-1.9) years and 1.9 (1.5-2.2) years and BI 0-24: 0.5 (0.3-0.7) years and 0.8 (0.6-0.9) years. In multivariate logistic regression analysis with BI 80-100 as baseline and controlling for significant covariates (sex, age, CCI, and diseases of cancer, haematology, cardiovascular, respiratory, infectious and bone and connective tissues) the odds ratios for 3 and 12 months survival (95%-CI) decreased with declining BI: BI 50-79: 0.74 (0.55-0.99) (p < 0.05) and 0,80 (0.65-0.97)(p < 0.05); BI 25-49: 0.44 (0.33-0.59)(p < 0.001) and 0.55 (0.45-0.68)(p < 0.001); and BI 0-24: 0.18 (0.14-0.24)(p < 0.001) and 0.29 (0.24-0.35)(p < 0.001) respectively.ConclusionBI is a strong independent predictor of survival in older patients admitted to an acute geriatric unit. These data suggest that assessment of ADL may have a potential role in decision making for the clinical management of frail geriatric inpatients.

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“…The association between co-morbidity and survival was also found previously in a study on 1,567,659 admissions [21], but in contrast to our study data on functional status was lacking.…”

Section: Discussionsupporting

confidence: 79%

Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

et al. 2012

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“…Our cohort of nonagenarians had a similar in-hospital mortality rate (15.2%) to those of previous reports (17–22%), but different mortality predictors [23]–[25]. Past research has mostly focused on long-term outcomes in community-dwelling nonagenarians, and few have investigated short-term goals (e.g., discharge from acute care hospitals) [4].…”

Section: Discussionsupporting

confidence: 65%

In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

et al. 2013

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Background/AimsThe elderly constitute an increasing proportion of admitted patients worldwide. We investigate the determinants of hospital length of stay and outcomes in patients aged 90 years and older.MethodsWe retrospectively analyzed all admitted patients aged >90 years from the general medical wards in a tertiary referral medical center between August 31, 2009 and August 31, 2012. Patients’ clinical characteristics, admission diagnosis, concomitant illnesses at admission, and discharge diagnosis were collected. Each patient was followed until discharge or death. Multivariate logistic regression analysis was utilized to study factors associated with longer hospital length of stay (>7 days) and in-hospital mortality.ResultsA total of 283 nonagenarian in-patients were recruited, with 118 (41.7%) hospitalized longer than one week. Nonagenarians admitted with pneumonia (p = 0.04) and those with lower Barthel Index (p = 0.012) were more likely to be hospitalized longer than one week. Multivariate logistic regression analysis revealed that patients with lower Barthel Index (odds ratio [OR] 0.98; p = 0.021) and those with heart failure (OR 3.05; p = 0.046) had hospital stays >7 days, while patients with lower Barthel Index (OR 0.93; p = 0.005), main admission nephrologic diagnosis (OR 4.83; p = 0.016) or acute kidney injury (OR 30.7; p = 0.007) had higher in-hospital mortality.ConclusionIn nonagenarians, presence of heart failure at admission was associated with longer hospital length of stay, while acute kidney injury at admission predicted higher hospitalization mortality. Poorer functional status was associated with both prolonged admission and higher in-hospital mortality.

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“…This trend impresses to be independent of the cause of hospitalization. Currently, as life expectancy has increased, hospitalizations in the elderly population are increasingly common [25] and further, these patients tend to be more fragile and have more comorbidities [18]. We found a difference in the peak of mortality among patients hospitalized for clinical cause (group 50-59 years) and surgical cause (60-69 years).…”

Section: Discussionmentioning

confidence: 85%

Inhospital mortality among clinical and surgical inpatients recently diagnosed with venous thromboembolic disease

Posadas‐Martinez

Vázquez

Ratti

et al. 2015

J Thromb Thrombolysis

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Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients, and pulmonary embolism is responsible for 5-10 % of all hospital deaths. To estimate the hospital mortality in hospitalized patients who developed VTE during hospitalization. Prospective cohort of all adult inpatients >17 years admitted to the hospital between August 2006 and August 2013, and follow-up until discharge to measure death. VTE incident cases were captured prospectively from the Institutional Registry of Thromboembolic disease in a tertiary hospital care in Buenos Aires. In hospital global mortality and fatality rate of inpatients with VTE was calculated. The cumulative incidence of VTE was 1.8 % (95 % CI 1.77-1.93 %), representing 1.32 % (95 % CI 1.23-1.41 %) in the subgroup of surgical patients and 2.1 % (95 % CI 1.9-2.2 %) in clinical inpatients. The overall hospital mortality was 2.4 % (95 % CI 2.35-2.53); being 3.95 % (95 % CI 3.78-4.12) in clinical inpatients and 1.15 % (95 % CI 1.06-1.23) in surgical patients. The death in patients who had developed VTE, represented between 4 and 7 % of hospital deaths, and it increases with age in both clinical and surgical patients. In Argentina there are few data of hospital mortality in patients with VTE. This information is useful when assessing the need for resources for prevention, diagnosis and treatment in inpatients.

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Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain

Cited by 55 publications

References 15 publications

Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

Inhospital mortality among clinical and surgical inpatients recently diagnosed with venous thromboembolic disease

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