Predictors of In-Hospital Mortality Among Older Patients

Abstract

OBJECTIVE:The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit.INTRODUCTION:The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality.METHODS:This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine).RESULTS:The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65–6.44, P<.001), neoplastic disease (OR=3.38, CI=2.11–5.42, P<.001), serum albumin levels at admission <3.3mg/dL (OR=3.23, CI=2.03–5.13, P<.001), serum creatinine levels at admission ≥ 1.3mg/dL (OR=2.39, CI=1.53–3.72, P<.001), history of heart failure (OR=1.97, CI=1.20–3.22, P=.007), immobility (OR=1.84, CI=1.16–2.92, P =.009), and advanced age (OR=1.03, CI=1.01–1.06, P=.019).CONCLUSIONS:This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.

Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria

“…Other causes of death were tuberculosis 7.7%, renal failure 6.9%, and hypertensive heart failure 5.8%. Less frequent causes of deaths were grouped as "others" and the group accounted for [9] Silva et al in Brazil documented 16.4% [12] and Shoko and his colleagues from Japan reported 17.7% morality rate amongst older patients. [13] The wide differences in mortality rates among the different studies can be attributed to factors such as degree of hospital specialization, patient's characteristics, and severity of illness at the time of presentation.…”

“…[13] The wide differences in mortality rates among the different studies can be attributed to factors such as degree of hospital specialization, patient's characteristics, and severity of illness at the time of presentation. [9,12,14] Financial constraint is also an important issue that could influence outcome of hospitalization in resource scarce nation like Nigeria. [6][7][8] There exists in many developing nations poor social service to cater for older citizens, as a result they are solely dependent on their children and relatives for upkeep and settlement of health bills.…”

“…This is lower than mean age from other works from both developing and developed nations. [9,[11][12][13][14][15] It is plausible that the wide difference in age at death in those studies compared to ours is due to improvement in standard of living, better socioeconomic facilities, and higher life expectancy. Male deaths constituted 59% of mortality in our report and mean age at deaths in males was lower than in the females.…”

Fatores de risco para óbito em pacientes idosos gravemente enfermos

“…In a recent study with 856 patients aged 60 to 104 years admitted to a tertiary hospital in Brazil, found a mortality rate of 16.4%, and the factors associated with death were delirium, neoplastic disease, serum albumin levels at admission < 3.3mg/dL, serum creatinine level at admission ≥ 1.3mg/dL, history of heart failure, immobility and advanced age. (23) In a recent study with patients older than 80 years in an ICU after surgery the factors associated with death were need of vasoactive drugs in the first and second 24h. (24) In a recent study with critically ill patients aged > 80 years showed that the most important determinants of ICU mortality were emergency (versus elective) admission, non-operative (versus post-operative) source of admission and a higher age-adjusted APACHE II score.…”

Mortality at a Portuguese Internal Medicine Service: Is Patient Allocation a Determinant Factor?

“…Despite the problem's size, few studies have been dedicated to determine mortality predictors among hospitalized patients [1].…”