Six-month outcome of elderly people hospitalized via the emergency department: the SAFES cohort
M Dramé, P O Lang, J-L Novella, D Narbey, R Mahmoudi, I Lanièce, D Somme, J-B Gauvain, D Heitz, T Voisin, B de Wazières, R Gonthier, J Ankri, O Saint-Jean, C Jeandel, P Couturier, F Blanchard, D Jolly, M Dramé, P O Lang, J-L Novella, D Narbey, R Mahmoudi, I Lanièce, D Somme, J-B Gauvain, D Heitz, T Voisin, B de Wazières, R Gonthier, J Ankri, O Saint-Jean, C Jeandel, P Couturier, F Blanchard, D Jolly
Abstract
Background: The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization.
Methods: A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period.
Results: Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR=1.83; 95% CI=1.27-2.62) or a higher number of children (HR=0.86; 95% CI=0.78-0.96), balance problems (HR=1.72; 95% CI=1.19-2.47), malnutrition or risk thereof (HR=1.93; 95% CI=1.24-3.01), and dementia syndrome (HR=1.88; 95% CI=1.32-2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR=1.92; 95% CI=1.17-3.16), delirium (HR=1.80; 95% CI=1.24-2.62), and a high level of comorbidity (HR=1.62; 95% CI=1.09-2.40). Institutionalization (HR=1.92; 95% CI=1.37-2.71) and unplanned readmission (HR=4.47; 95% CI=3.16-2.71) within the follow-up period were also found as independent predictors.
Conclusion: The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects' prognosis favorably.
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Source: PubMed