Age and Ageing Advance Access published online on March 29, 2007
Age and Ageing, doi:10.1093/ageing/afm033
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Article |
Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care
1 Department of Geriatrics, Hospital de la Santa Creu de Vic, Rambla Hospital, 52, 08500 Vic, Barcelona, Spain
2 Department of Clinical Epidemiology, Hospital General de Vic, Francesc Pla "El Vigatà", 1, 08500 Vic, Barcelona, Spain
Address correspondence to: A. Arnau Bartés. Tel: (+34) 93 8833001; Fax: (+34) 93 8856761. Email: aarnau{at}hgv.cat
Objective: to determine the association between functional and nutritional changes caused by an acute illness requiring hospitalisation and 6-month mortality.
Design: hospital-based prospective longitudinal cohort study.
Setting: acute care centre (Hospital General de Vic, Barcelona Province, Spain). Post-acute care centre (Hospital de la Santa Creu de Vic, Barcelona Province, Spain).
Subjects: hundred sixty five patients aged 75 years and older, hospitalised for an acute event.
Methods: functional status (Barthel and Lawton Indices), cognitive status (Short Portable Mental Status Questionnaire), nutritional status (Mini Nutritional Assessment, albumin, cholesterol), depressive symptoms (Geriatric Depression Scale), co-morbidity (Charlson Index) and self-rated health status were collected upon admission to the post-acute care centre. Functional and nutritional status were assessed 1, 3 and 6 months after admission by a trained staff of geriatricians. Six-month mortality was the main outcome variable. Survival analysis was performed with functional and nutritional status as time-dependent variables.
Results: the mean age of the cohort was 83.3 years (SD 5.1) and 68.5% were female. Six-month mortality was 29.1% (95% CI: 22.2–36.7). The variables associated with mortality in bivariate analysis were: gender, Barthel Index (2 weeks before admission), Lawton Index (2 weeks before admission), Charlson Index, Barthel Index (time-dependent), Mini Nutritional Assessment (MNA) (time-dependent) and cognitive status. The variables associated with mortality in multivariate analysis were: gender, Barthel Index (2 weeks before admission), Charlson Index and MNA (time-dependent).
Conclusions: functional and nutritional changes due to an acute illness have a statistical and clinical prognostic value and should be assessed along with other well-known relevant prognostic factors.
Keywords: frail elderly, prognostic factors, geriatric assessment, longitudinal study, mortality
Received 18 August 2006; accepted in revised form 14 February 2007.