Six-month outcome of elderly people hospitalized via the emergency department: The SAFES cohort

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• 作者：M. Dramé ; ^a ; ^b ; ^{mdrame@chu-reims.fr} ; P.O. Lang^a ; ^c ; J.-L. Novella^a ; ^b ; D. Narbey^a ; R. Mahmoudi^a ; ^b ; I. Laniè ; ce^d ; D. Somme^e ; J.-B. Gauvain^f ; D. Heitz^g ; T. Voisin^h ; B. de Waziè ; resⁱ ; R. Gonthier^j ; J. Ankri^k ; O. Saint-Jean^e ; C. Jeandel^l ; P. Couturier^d ; F. Blanchard^a ; ^b ; D. Jolly^a ; ^m
• 关键词：Elderly ; Institutionalization ; Mortality ; Prediction ; Comprehensive geriatric assessment ; SAFES cohort
• 刊名：Revue d'篓娄pid篓娄miologie et de Sant篓娄 Publique
• 出版年：2012
• 期刊代码：pca329_03987620
• 类别：med
• 出版时间：June, 2012
• 卷：60
• 期：3
• 页码：189-196
• 文件大小：462 K

摘要

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鈥?prognosis favorably.