Predictors of Immediate and 6‐Month Outcomes in Hospitalized Elderly Patients

Narain, Prakash; Rubenstein, Laurence Z.; Wieland, G. Darryl; Rosbrook, Brad; Strome, L. Sandra; Pietruszka, Fern M.; Morley, John E.

doi:10.1111/j.1532-5415.1988.tb04259.x

Cited by 319 publications

(226 citation statements)

References 20 publications

Supporting

Mentioning

195

Contrasting

Unclassified

Order By: Relevance

“…Individual diagnoses were not examined as predictors of mortality because previous studies in older populations have shown that functional measures are stronger predictors of hospital outcomes than medical diagnoses or diagnosis-related groups. 42,43 The inclusion of functional and cognitive measures in our models provided additional control for important prognostic variables, which have been widely recognized to reflect the overall "burden of illness" and to exert substantial prognostic impact on outcomes of hospitalization. 26,[42][43][44] Taken together, the APACHE II, functional, and cognitive measures provide a potent and plausible indicator of illness severity and comorbidity for older hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Does delirium contribute to poor hospital outcomes?

et al. 1998

View full text Add to dashboard Cite

OBJECTIVE:To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. DESIGN:Three prospective cohort studies. SETTING: Three university-affiliated teaching hospitals.PATIENTS: Consecutive samples of 727 patients, aged 65 years and older. MEASUREMENTS AND MAIN RESULTS: Delirium, defined as an acute disorder of attention and global cognitive functioning, has assumed increasing importance in the United States, with the burgeoning population of older citizens. In 1993, 35% of the population aged 65 years and older was hospitalized during the year, accounting for 36% of all hospital stays and 48% of all days of hospital care. 1 The oldest group ( Ͼ 75 years) is the most rapidly growing sector of the U.S. population, 1 and is particularly vulnerable to developing delirium during acute illness and hospitalization. 2 Previous studies have estimated that delirium occurs in 14% to 56% of elderly hospitalized patients, with associated hospital mortality rates of 10% to 65%. 2 Previous studies have documented that delirium is associated with poor outcomes, such as increased mortality rates, prolonged length of hospital stay, increased rates of institutional placement, and functional and cognitive decline. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, the unanswered question remains: Does delirium itself contribute to this poor prognosis, or does delirium simply serve as a marker identifying patients with poor prognostic features due to severe illness, dementia, functional impairment, advanced age, and the like? Unfortunately, many of the previous studies, which were not all designed to address this research question directly, were hindered by inadequate control for these potential confounders and by small numbers of relatively infrequent outcome events.The objective of the present study was to examine the independent contribution of baseline delirium to hospital mortality, institutionalization, functional decline, and length of stay in three large prospective cohort studies of elderly hospitalized patients. 20 Uniform prospective data collection for this project facilitated collection of standardized information on delirium, study outcomes, and potential confounders. Our underlying hypothesis was that baseline delirium (present at admission) would be an important prognostic predictor even after controlling for underlying illness severity, age, dementia and functional status.

show abstract

Section: Discussionmentioning

confidence: 99%

Does delirium contribute to poor hospital outcomes?

et al. 1998

View full text Add to dashboard Cite

show abstract

“…For older patients, hospitalization has been associated with a variety of adverse outcomes, including high rates of functional decline, increased risk of medical and iatrogenic events, and increased likelihood of nursing home placement upon discharge [1][2][3][4][5][6][7][8][9][10]. Low mobility, defined as activity that is limited to a bed or chair, is also a common event during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Validation of use of wireless monitors to measure levels of mobility during hospitalization

Brown

Roth

Allman

2008

JRRD

View full text Add to dashboard Cite

Abstract-Accurate methods of measuring levels of mobility during hospitalization are lacking. We validated the use of wireless monitors to measure three levels of mobility during hospitalization: (1) lying, (2) sitting, and (3) standing or walking. Hospitalized medical patients 65 years or older who did not have delirium or dementia and could walk in the 2 weeks before admission were eligible. Wireless monitors, which recorded average position every 20 seconds, were attached to the thigh and ankle of consented patients. Direct behavioral observation by trained observers who recorded mobility level was used as the gold standard. Forty-seven male patients (mean age 73.9 years), with a mean length of stay of 5.3 days, generated 187 two-hour direct behavioral observation periods. Wireless monitors were highly correlated with direct behavioral observations. The median kappa was 0.92 and the kappa across all observations was 0.88, indicating excellent agreement. This study demonstrates that wireless monitors validly measure mobility levels among older hospitalized patients.

show abstract

“…2 Decline in function and increasing dependence on assistance with activities of daily living have been strongly associated with hospital admission [6][7][8] and mortality in older adults. [9][10][11][12] The relationship between functional decline and hospital admission raises the possibility that function may contribute to geographic variation in hospital use, either through regional variation in functional debility or regional variation in available treatment resources or practice patterns related to functional decline and disability.…”

Section: Introductionmentioning

confidence: 99%