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Observational Study
. 2019 Feb;67(2):352-356.
doi: 10.1111/jgs.15662. Epub 2018 Nov 13.

Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care

Alison M Mudge  1   2 , Prue McRae  1   2 , Ruth E Hubbard  3 , Nancye M Peel  3 , Wen Kwang Lim  4   5 , Adrian G Barnett  2 , Sharon K Inouye  6
Affiliations
Observational Study

Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care

Alison M Mudge et al. J Am Geriatr Soc. 2019 Feb.

Abstract

Objectives: To propose a new multicomponent measure of hospital-associated complications of older people (HAC-OP) and evaluate its validity in a large hospital sample.

Design: Observational study using baseline (pre-intervention) data from the Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital cluster randomized controlled trial.

Setting: Acute medical and surgical wards in 4 hospitals in Queensland, Australia.

Participants: Individuals aged 65 and older (mean age 76, 48% female) with a hospital stay of 72 hours or longer (N=434).

Measurements: We developed a multicomponent measure including 5 well-recognized hospital-associated complications of older people: hospital-associated delirium, functional decline, incontinence, falls, and pressure injuries. To evaluate construct validity, we examined associations with common risk factors (aged ≥75, functional impairment, cognitive impairment, history of falls). To evaluate predictive validity, we examined the association between length of stay, facility discharge, and 6-month mortality and any HAC-OP and total number of HAC-OP.

Results: Overall, 192 (44%) participants had 1 or more HAC-OP during their admission. Any HAC-OP was strongly associated with the proposed shared risk factors, and there was a strong and graded association between HAC-OP and length of stay (9.1±7.4 days for any HAC-OP vs 6.8 ±4.1 days with none, p < .001), facility discharge (59/192 (31%) vs 27/242 (11%), p < .001) and 6-month mortality (26/192 (14%) vs 17/242 (7%), p = .02).

Conclusion: This study provides evidence of construct and predictive validity of the proposed measure of HAC-OP as a potential outcome measure for research investigating and improving hospital care of older people. J Am Geriatr Soc 67:352-356, 2019.

Keywords: delirium; functional decline; geriatric syndrome; hospitalization; incontinence.

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Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to declare

Figures

Figure 1.
Figure 1.
Clinical outcomes according to number of hospital-associated complications of older people (HAC-OP). A. Mean length of stay in days (error bars show 95% confidence intervals). B. Percentage of participants discharged to facility (continuing, rehabilitation, post-acute or new nursing home care). C. Percentage of participants who died within 6 months of admission
See this image and copyright information in PMC

References

    1. Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc. 2003;51(4):574–576. - PubMed
    1. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–791. - PMC - PubMed
    1. Olde Rikkert M, Rigaud A, van Hoeyweghen R, de Graaf J. Geriatric syndromes: medical misnomer or progress in geriatrics? Neth J Med. 2003;61(3):83–87. - PubMed
    1. Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J. 2008;38(1):16–23. - PubMed
    1. Buurman BM, Hoogerduijn JG, de Haan RJ, et al. Geriatric conditions in acutely hospitalized older patients: prevalence and one-year survival and functional decline. PLoS One. 2011;6(11):e26951. - PMC - PubMed

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