Risk Factors for Early and Late Mortality in Hospitalized Older Patients: The Continuing Importance of Functional Status

Abstract

Background. Prognostic information collected at hospital admission may be useful in defining care objectives and in deciding on therapy for older people. The aim of our study was to identify admission risk factors for in-hospital and postdischarge mortality. Methods. The study included 987 patients aged 70 years and older admitted to the geriatric ward of San Giovanni Battista Hospital in Torino during 1995 and 1996. Demographic, clinical, and functional variables were collected on admission to hospital and examined as potential risk factors for mortality during hospitalization and at 5 years of follow-up. Results. During their hospital stay, 147 patients (14.9%) died. Risk factors independently associated with in-hospital mortality included functional impairment (Activities of Daily Living [ADL]) (OR [odds ratio] 1.73, CI [confidence interval] 95% 1.02–2.95), dependence related to medical conditions (OR 2.18, CI 95% 1.39–3.42), cerebrovascular disease (OR 3.23, CI 95% 1.64–6.37), cancer (OR 4.52, CI 95% 1.99–10.24), albumin 3.0–3.4 g/dl (OR 4.51, CI 95% 2.76–7.35), albumin 3 mg/dl (OR 2.55, CI 95% 1.10–5.93), and fibrinogen ≥452 mg/dl (OR 1.91, CI 95% 1.26–2.89). During the 5-year follow-up, 553 patients (67.7%) died. Variables independently associated with mortality in multivariate analysis were age 75–84 years (HR [hazard ratio] 1.40, CI 95% 1.10–1.78), ≥85 years (HR 2.08, CI 95% 1.59–2.72), male sex (HR 1.50, CI 95% 1.24–1.81), ADL dependency (HR 1.24, CI 95% 1.01–1.52), ≥5 errors on Short Portable Mental Status Questionnaire (HR 1.34, CI 95% 1.10–1.63), dependence on Dependence Medical Index (HR 1.36, CI 95% 1.10–1.67), presence of cancer (HR 2.58, CI 95% 1.80–3.71), hemoglobin ≤11 g/dl (HR 1.46, CI 95% 1.17–1.81), and Charlson's Index ≥2 (HR 1.49, CI 95% 1.14–1.95). Conclusions. A complete functional and clinical evaluation at hospital admission permits identification of patients at higher risk of early and long-term mortality.