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. 2008 May 14:8:10.
doi: 10.1186/1471-2318-8-10.

Adverse outcomes following hospitalization in acutely ill older patients

Roger Y Wong  1 , William C Miller
Affiliations

Adverse outcomes following hospitalization in acutely ill older patients

Roger Y Wong et al. BMC Geriatr. .

Abstract

Background: The longitudinal outcomes of patients admitted to acute care for elders units (ACE) are mixed. We studied the associations between socio-demographic and functional measures with hospital length of stay (LOS), and which variables predicted adverse events (non-independent living, readmission, death) 3 and 6 months later.

Methods: Prospective cohort study of community-living, medical patients age 75 or over admitted to ACE at a teaching hospital.

Results: The population included 147 subjects, median LOS of 9 days (interquartile range 5-15 days). All returned home/community after hospitalization. Just prior to discharge, baseline timed up and go test (TUG, P < 0.001), bipedal stance balance (P = 0.001), and clinical frailty scale scores (P = 0.02) predicted LOS, with TUG as the only independent predictor (P < 0.001) in multiple regression analysis. By 3 months, 59.9% of subjects remained free of an adverse event, and by 6 months, 49.0% were event free. The 3 and 6-month mortality was 10.2% and 12.9% respectively. Almost one-third of subjects had developed an adverse event by 6 months, with the highest risk within the first 3 months post discharge. An abnormal TUG score was associated with increased adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.03 to 1.59, P = 0.03. A higher FMMSE score (adjusted HR 0.89, 95% CI 0.82 to 0.96, P = 0.003) and independent living before hospitalization (adjusted HR 0.42, 95% CI 0.21 to 0.84, P = 0.01) were associated with reduced risk of adverse outcome.

Conclusion: Some ACE patients demonstrate further functional decline following hospitalization, resulting in loss of independence, repeat hospitalization, or death. Abnormal TUG is associated with prolonged LOS and future adverse outcomes.

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Figures

Figure 1
Figure 1
Study flow diagram. Of the original 150 subjects recruited, 88 participated at the 3-month and 72 participated at the 6-month follow up after discharge from ACE. LTCF = long term care facility.
Figure 2
Figure 2
Kaplan-Meier survival curve at 3 months and 6 months. The estimated survival probability is 0.76 and 0.67 respectively.
See this image and copyright information in PMC

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