Predictors of mortality among elderly dependent home care patients

Abstract

BackgroundThe purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program.MethodsA one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received.Results1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death.ConclusionsComorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care.

Factors associated with unexpected admissions and mortality among low‐functioning older patients receiving home medical care

“…10 Indeed, a Spanish study in a cohort of dependent older adults showed that higher CCI predicted mortality. 6 In the current study, CCI predicted unexpected hospital admission, but not mortality. Several studies have reported an association between CCI and hospitalization in various settings.…”

“…[2][3][4][5] A largescale study carried out in Spain clearly showed that multicomorbidity was associated with mortality in older dependent patients. 6 However, it is largely unknown how these four factors are associated with the prognosis in frail older adults receiving home medical care for terminal illness.…”

Chronic wound repair and healing in older adults: Current status and future research

“…Chronic wounds have a profound effect on quality of life (QOL), as assessed by generic and wound-specific instruments or by health utility. [4][5][6] The impact is similar to that seen with kidney or heart failure, and QOL decline is particularly precipitous among older adults. However, overall QOL among older populations with chronic wounds is poorly understood.…”

Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings

“…12 Badia and colleagues 13 reported results of a longitudinal of 1001 elderly, dependent patients living at home; approximately 25% patients died during the 1-year follow-up period. 13 Variables that independently predict mortality included existence of 1 or more pressure ulcers.…”