Leishmaniasis/diagnosis , Aged, 80 and over , Arthritis, Rheumatoid/complications , Female , Fever/complications , Fever/parasitology , Humans , Leishmaniasis/complications , Pericardial Effusion/complications , Pericardial Effusion/parasitology , Severity of Illness Index , Splenomegaly/complications , Splenomegaly/parasitology
BACKGROUND/AIM: Estimation of mortality in elderly patients is difficult yet very important when planning care. Previous tools are complicated or do no take into account some major determinants of mortality (i.e., frailty). We designed a simple, accurate, and non-disease-specific tool to predict individual mortality risk after hospital discharge in older adults. METHODS: Patients admitted to the Acute Geriatric Unit were assessed at adission and at discharge and contacted 6 and 12 months later. Determinants of mortality were obtained. Using multivariable analysis, beta coeffcicients were calculated to build 2 scores able to predict mortality at 6 and 12 months after discharge. The scores were tested on a sample comprising 75% of the patients, who were randomly selected; they were validated using the remaining 25%. Discrimination was assessed using ROC curves. Scores were calculated for each patient and divided into tertiles. Survival analysis was performed. RESULTS: Determinants of mortality at 6 months were dependent ambulation at baseline, full dependence at discharge, length of stay, pluripatology, pressure ulcers, low grip strength, malignacy, and male gender. At 12 months the determinants were: dependent amblation at baseline, full dependence at discharge, pluripatology, low BMI, low grip strength, heart failure, malignacy, and male gender. Discrimination and calibration were excellent. Survival analysis demonstrated different survival trajectories (p<0.001) for each tertile in both scores. CONCLUSIONS: Our incices provide accurate prognostic information in elderly patients after discharge. They can be calculated easily, quickly and do not require technical or laboratory support, thus endorsing their value in dalily clinical practice.
Geriatric Assessment/methods , Health Status Indicators , Hospitalization/statistics & numerical data , Mortality , Aged , Aged, 80 and over , Female , Frail Elderly , Humans , Logistic Models , Male , Multivariate Analysis , Patient Discharge , Prognosis , ROC Curve , Risk , Risk Assessment , Risk Factors , Survival Analysis
Humans , Female , Aged, 80 and over , Epidermolysis Bullosa/complications , Epidermolysis Bullosa/diagnosis , Epidermolysis Bullosa/drug therapy , Diagnosis, Differential , Epidermolysis Bullosa/physiopathology , Osteoarthritis, Knee/complications , Depression/complications , Repertory, Barthel , Adrenal Cortex Hormones/therapeutic use , Biopsy/methods
INTRODUCTION: In some elderly individuals, hospital admission for acute illness represents a possible loss of autonomy not always related to the reason for hospitalization. The importance of this problem and the possible existence of differences among services are not sufficiently well known. OBJECTIVE: To compare the incidence of functional decline and associated risk factors during hospitalization between an acute care geriatric unit (GU) and an internal medicine (IM) ward. MATERIAL AND METHODS: We performed a prospective, cohort study. Sociodemographic characteristics, comorbidity, cause of admission, severity, use of several hospital practices, mortality rate and functional decline were analyzed. Functional decline was defined as the loss of independence to perform at least one of the basic activities of daily living with respect to preadmission status. The influence of the admitting service was evaluated by a multiple logistic regression model. RESULTS: A total of 379 patients were included (140 in the GU and 239 in IM). Compared with IM, patients in the GU were older (87 vs 81.5; P< .001), had a greater prevalence of dementia and visual alterations and worse previous functional status. The proportion of patients who spent > 48 hours in bed and who received nocturnal medication was lower in the GU. The functional decline rate was greater in IM than in the GU (60.2% vs 48%; P=.04). Length of hospital stay was similar in both groups (7.7 vs 8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization, bed rest for > 48 h, psychotropic drugs, nocturnal medication and physical restraints. In the multivariate analysis, admission to IM was associated with a greater risk of functional decline. CONCLUSIONS: Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.
Activities of Daily Living , Acute Disease , Geriatrics , Hospitalization , Aged, 80 and over , Humans , Internal Medicine , Prospective Studies , Risk Factors
Introducción: el ingreso hospitalario por enfermedad aguda suponepara determinados ancianos de riesgo una pérdida de autonomíano siempre relacionada con la enfermedad causante dedicha hospitalización. La importancia de este problema en nuestromedio sanitario, y si existen diferencias según el servicio enque se produzca el ingreso, no se conocen suficientemente.Objetivo: estudiar la incidencia de deterioro funcional, factoresasociados y diferencias entre los servicios de medicina interna ygeriatría, en ancianos hospitalizados por enfermedad aguda.Material y métodos: estudio prospectivo de cohortes. Analizamoslas características sociodemográficas, la comorbilidad motivode ingreso y gravedad, el uso de varias prácticas hospitalarias,la tasa de mortalidad y de pérdida funcional durante elingreso. Se definió deterioro funcional como la pérdida de autonomíapara al menos una de las actividades básicas de la vidadiaria, con respecto a la situación previa al ingreso. La influenciadel servicio se analizó mediante un modelo de regresión logísticamúltiple.Resultados: estudiamos a 379 pacientes (140 en el servicio degeriatría [SG] y 239 en medicina interna [MI]). Los pacientes ingresadosen SG eran mayores (87 frente a 81,5 años; p < 0,001),había en ellos mayor porcentaje de demencia y alteraciones visualesy eran más dependientes. La proporción de pacientes quepermanecían en cama más de 48 h o recibían medicación nocturnaera menor en el SG. La incidencia de deterioro funcional fuemayor en MI que en el SG (el 60,2 frente al 48%; p = 0,04), conuna estancia hospitalaria similar (7,7 frente a 8,1; p = 0,37). Laedad, el síndrome confusional, la ausencia de movilización, el encamamiento> 48 h, el uso de psicofármacos y sujeciones o demedicación nocturna se asociaron a deterioro funcional. En elanálisis multivariable, el ingreso en MI se asoció a mayor riesgode deterioro funcional...(AU)
Introduction: in some elderly individuals, hospital admission foracute illness represents a possible loss of autonomy not alwaysrelated to the reason for hospitalization. The importance of thisproblem and the possible existence of differences among servicesare not sufficiently well known.Objective: to compare the incidence of functional decline andassociated risk factors during hospitalization between an acutecare geriatric unit (GU) and an internal medicine (IM) ward.Material and methods: we performed a prospective, cohortstudy. Sociodemographic characteristics, comorbidity, cause ofadmission, severity, use of several hospital practices, mortalityrate and functional decline were analyzed. Functional decline wasdefined as the loss of independence to perform at least one of thebasic activities of daily living with respect to preadmission status.The influence of the admitting service was evaluated by a multiplelogistic regression model.Results: a total of 379 patients were included (140 in the GU and239 in IM). Compared with IM, patients in the GU were older(87 vs 81.5; P<.001), had a greater prevalence of dementia andvisual alterations and worse previous functional status. The proportionof patients who spent > 48 hours in bed and who receivednocturnal medication was lower in the GU. The functional declinerate was greater in IM than in the GU (60.2% vs 48%; P=.04).Length of hospital stay was similar in both groups (7.7 vs8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization,bed rest for > 48 h, psychotropic drugs, nocturnal medicationand physical restraints. In the multivariate analysis, admissionto IM was associated with a greater risk of functionaldecline...(AU)
Humans , Male , Female , Aged , /trends , Acute Disease/epidemiology , Quality of Health Care/trends , Health Services for the Aged/trends , Frail Elderly/statistics & numerical data , Hospital Statistics , Humanization of Assistance
