Barbara Maero

Early re-hospitalization of elderly people discharged from a geriatric ward.

Background and aims: Hospitalized elderly patients generally have a high level of disability and comorbidity. In many cases, at hospital discharge, the achieved health status balance is poor, and consequently the risk of further disability and hospital readmission is great. Identifying factors leading to hospital readmission could be helpful in reducing such events. The aim of the study was to evaluate the incidence and predictive factors of hospital readmission. Methods: We conducted an observational cohort study of a group of patients discharged from the Geriatric Ward of the San Giovanni Battista Hospital, Torino (Italy). The study sample contained 839 patients aged 80.6±6.3 years. The average hospital stay was 17.5±18.9 days (range 1–274 days). Results: Follow-up lasted three months, at the end of which 107 patients (12.8%) had been readmitted, 83 (9.9%) had only one readmission and 24 (2.9%) one or more readmissions. The first readmission took place within 15 days of discharge for 24 patients (2.9%) and within 30 days of discharge for 27 (3.2%). A new hospital admission within 15 days of discharge increased the risk of mortality (RR=3) and also the probability of a second re-hospitalization. 10.1% patients died; 88.2% of the patients who died had at least one readmission, whereas only 4.2% of live patients had a new hospital admission. Conclusions: Tumors, dementia, comorbidity, high education level, day hospital course and period of convalescence were all significantly and independently related to readmission.

Post-hospitalization mortality in the elderly

The level of disability and polypathology in hospitalized elderly is usually high. Multidimensional and functional assessment allows to identify risk factors for clinical and functional failure of patients. Many studies point out that identifying predictors of high-risk patients is a necessary step in accurate targeting. We evaluated 395 subjects (175 women, 202 men, mean age 77.9 year) during their hospitalization in our Geriatric ward. Baseline data included: demographics variables, medical diagnosis, functional evaluation, and laboratory values. After a 6-month follow up 80 (20.2%) subjects died. In our study, male gender, dependence at the Dependence Medical Index (DMI), low serum albumin (< 2.8 g/dl), impaired score at the Instrumental Activities of Daily Living scale (IADL), score lower than 13.7 at the acute physiology and chronic health evaluation (APACHE II) and neoplasm were independent predictors of 6-month post-hospitalization mortality. The high mortality rate of our sample could be a marker of considerable frailty among elderly patients. Our study shows that a poor functional status is a more reliable prognostic factor than type and number of admitting diagnosis. Clinical evaluation, improved with information about functional status, is a feasible and practical way of detecting risk of short term post-hospitalization mortality of elderly subjects.

Risk factors of functional decline during hospitalization in the oldest old

Background and aims: The number of hospital admissions of the elderly is increasing and hospitalization often leads to functional decline. The aim of this study was to identify major risk factors for functional decline in the hospitalized oldest old. Methods: Prospective, observational, non-randomized study of patients aged ≥80 years, admitted for at least two days to the University Department of Geriatric Medicine of Torino, Italy, between November 2003 and November 2004. For detection of functional decline, the ADL scale was used, referring to the number of dependent ADL. Results: At discharge, ADL mean scores were significantly higher than on admission (2.5±2 vs 2.3±1.9, p<0.001). 23.9% of the sample lost at least one ADL function during hospitalization, and 19.2% were transferred to long-term care, compared with 5.4% of those with no functional decline. Length of hospitalization, neoplasm, low level of albumin and high number of drugs prescribed were associated with functional decline. At multivariate analysis, only in-hospital stay was an independent risk factor for functional decline (RR 1.1 per day of hospitalization, CI 1.03–1.14). Conclusions: Hospitalization of the oldest old increases the risk of functional decline, especially if prolonged. It is important to identify patients at high risk for functional decline after hospital admission.

Multidimensional assessment and risk factors for prolonged hospitalization in the elderly

Background and aims: Frailty, multiple pathologies, functional impairment and socioeconomic conditions can prolong the length of hospitalization in the elderly. The aim of our study was to analyze risk factors for prolonged hospitalization. Methods: Our sample included 1054 patients consecutively admitted to the University Department of Geriatric Medicine of Torino, Italy. We examined some demographic variables (age, sex, socioeconomic conditions), affective, cognitive and functional status, main pathologies, and blood pressure and some hematological parameters (hemoglobin, creatinine, albumin, sodium). Results: The number of functions lost to IADL and ADL, DMI (Dependent Medical Index) dependence, high levels of creatinine and low blood levels of albumin and sodium were associated with longer hospitalization, as also were the following clinical diagnoses: tumor, chronic obstructive pulmonary disease (COPD), hip fractures, peripheral arterial disease (PAD), and pressure sores. Independent predictors of prolonged hospitalization were: the number of functions lost to the ADL index, pressure sores, hip fracture, peripheral arterial disease with critical ischemia, and low levels of sodium. Conclusions: Multidimensional assessment is essential to identify medical, functional and socioeconomic problems, and can highlight risk factors for prolonged hospitalization.