Predictors of long-term mortality in oldest old patients (90+) hospitalized to medical wards via the emergency department: The safes cohort

Boissieu, Paul de; Mahmoudi, Rachid; Hentzien, Maxime; Toquet, S.; Novella, Jean‐Luc; Blanchard, F.; Jolly, Damien; Dramé, Moustapha

doi:10.1007/s12603-015-0515-y

Cited by 9 publications

(13 citation statements)

References 30 publications

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“…Tools predicting short-term falls and mortality post-discharge remain limited and are most often tailored to a specific group of patients based on their disease characteristics (6)(7)(8)(9)(10). Risk factors known to contribute to falls and mortality in hospitalized older patients include poor functional status, poor cognition, illness severity, comorbidities, and polypharmacy (11)(12)(13).…”

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confidence: 99%

Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

Reijnierse

Verlaan

Pham

et al. 2018

The Journals of Gerontology: Series A

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Background Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients. Methods The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases). Results The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate). Conclusions In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.

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confidence: 99%

Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

Reijnierse

Verlaan

Pham

et al. 2018

The Journals of Gerontology: Series A

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“…Mortality was reported as an outcome in respect of dementia in 16 studies. 12,42,55,56,77,90,97,[105][106][107][108][109][110][111][112][113] Nine studies reported in-hospital mortality. 42,55,77,90,97,105,106,110,111 Seven studies reported post-discharge mortality.…”

Section: Mortalitymentioning

confidence: 99%

“…42,55,77,90,97,105,106,110,111 Seven studies reported post-discharge mortality. 56,105,[107][108][109]112,113 One study reported a statistical difference in in-hospital mortality rates between patients with dementia and delirium, with a higher mortality rate among delirious patients. 97 Four studies found that in-hospital mortality was independently predicted by dementia.…”

Section: Mortalitymentioning

confidence: 99%

“…55,90,105,106 Three studies did not find a significant association between dementia and discharge mortality after adjusting for confounders. 105,112,113 Zekry et al 105 noted vascular or severe dementia to be associated with short-and long-term mortality. However, when vascular dementia was adjusted for in multivariate analysis, the effect of dementia (regardless of its aetiology) was not associated with in-hospital, 1-year post-discharge or 5-year post-discharge mortality.…”

Section: Mortalitymentioning

confidence: 99%

“…A total of 38 studies reported mortality, which was expressed differently depending on the study: chiefly in-hospital and/or post-discharge mortality. 49,[55][56][57]59,60,63,66,69,70,73,90,92,[94][95][96][97]109,112,113,[116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131] It was also reported as a composite outcome and, less frequently, as survival rates/mean number of days survived.…”

Section: Mortalitymentioning

confidence: 99%

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Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study

Reynish

Hapca

Walesby

et al. 2021

Health Serv Deliv Res

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Background Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions. Objective This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013. Design For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost. Data sources Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set. Results In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower. Limitations A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders. Conclusions Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways. Future work Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital. Study registration This study is registered as PROSPERO CRD42015024492. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

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Non-pharmacological interventions to prevent or treat delirium in older patients: Clinical practice recommendations the SENATOR-ONTOP series

Abraha

Rimland

Trotta

et al. 2016

The Journal of nutrition, health and aging

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Predictors of long-term mortality in oldest old patients (90+) hospitalized to medical wards via the emergency department: The safes cohort

Abstract: Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.

Cited by 9 publications

References 30 publications

Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients

Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study

Non-pharmacological interventions to prevent or treat delirium in older patients: Clinical practice recommendations the SENATOR-ONTOP series

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