Risk factors for early and late mortality in hospitalized older patients: the continuing importance of functional status.

BACKGROUND: Prognostic information collected at hospital admission may be useful in defining care objectives and in deciding on therapy for older people. The aim of our study was to identify admission risk factors for in-hospital and postdischarge mortality. METHODS: The study included 987 patients aged 70 years and older admitted to the geriatric ward of San Giovanni Battista Hospital in Torino during 1995 and 1996. Demographic, clinical, and functional variables were collected on admission to hospital and examined as potential risk factors for mortality during hospitalization and at 5 years of follow-up. RESULTS: During their hospital stay, 147 patients (14.9%) died. Risk factors independently associated with in-hospital mortality included functional impairment (Activities of Daily Living [ADL]) (OR [odds ratio] 1.73, CI [confidence interval] 95% 1.02-2.95), dependence related to medical conditions (OR 2.18, CI 95% 1.39-3.42), cerebrovascular disease (OR 3.23, CI 95% 1.64-6.37), cancer (OR 4.52, CI 95% 1.99-10.24), albumin 3.0-3.4 g/dl (OR 4.51, CI 95% 2.76-7.35), albumin <3.0 g/dl (OR 6.83, CI 95% 3.59-13.0), creatinine 1.5-3 mg/dl (OR 2.23, CI 95% 1.36-3.65), creatinine >3 mg/dl (OR 2.55, CI 95% 1.10-5.93), and fibrinogen >/=452 mg/dl (OR 1.91, CI 95% 1.26-2.89). During the 5-year follow-up, 553 patients (67.7%) died. Variables independently associated with mortality in multivariate analysis were age 75-84 years (HR [hazard ratio] 1.40, CI 95% 1.10-1.78), >/=85 years (HR 2.08, CI 95% 1.59-2.72), male sex (HR 1.50, CI 95% 1.24-1.81), ADL dependency (HR 1.24, CI 95% 1.01-1.52), >/=5 errors on Short Portable Mental Status Questionnaire (HR 1.34, CI 95% 1.10-1.63), dependence on Dependence Medical Index (HR 1.36, CI 95% 1.10-1.67), presence of cancer (HR 2.58, CI 95% 1.80-3.71), hemoglobin /=2 (HR 1.49, CI 95% 1.14-1.95). CONCLUSIONS: A complete functional and clinical evaluation at hospital admission permits identification of patients at higher risk of early and long-term mortality.

[Malnutrition and dementia: importance of care during food intake]. / Malnutrizione e demenza: importanza di una corretta assistenza durante il pasto.

Aim of this work is to assess the effects on nutritional status of appropriate care in food intake in demented patients. In a long term care in Turin, we enrolled 96 patients aged 75-103 years free from metabolic, hematologic and neoplastic diseases and not showing signs of acute illness. Seventy seven of these patients were affected by dementia. No statistically significant differences were found between demented patients and controls in nutritional status and daily nutrient intake and only need for care in food intake was independently associated with dementia. Our data demonstrate that similar caloric intakes can be obtained in demented and non demented patients with an appropriate level of care in food intake.

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.

[An index for evaluation of cognitive-behavioral disorders in elderly people living in nursing homes]. / Un indice di valutazione dei disturbi cognitive-comportamentali nell'anziano istituzionalizzato.

Aim of the study was to create an instrument (DISCO Index) to evaluate cognitive-behavioural disturbances in elderly people. We considered n. 192 elderly people living in Torino's nursing homes, n. 76 people screened by the Geriatric Evaluation Unit (GEU) of S. Giovanni Battista Hospital in Torino and n. 136 subjects evaluated by a Torino's District GEU. Mean age was 81.8 +/- 8.3 years. By evaluating cognitive status and behavioural disturbances we obtained a list of conditions referring to three different degrees of severity depending on care needs. The three categories have been defined as: group A: absent or light cognitive and behavioural disturbances; group B: significant impairment of space-timing orientation, hallucinations and delirium, frequent verbal abuse (outrage, menace), feeding alteration; group C: total disturbance of sleep--awakeness rhythm, frequent real or threatened physical assault, wandering or escape attempts, suicidal ideas or suicidal trials, sever feeding alterations. Functional status was also considered by ADL. 41.1% of the study population belongs to group A, 50.5% to group B and 8.4% to group C. Functional status in the sample was seriously impaired in 64.4% (autonomy loss in more then three functions) while only 9.4% of the subjects was autonomous. The totally of people belonging to the group C was found to be dependent in ADLs.