Adverse outcomes following hospitalization in acutely ill older patients

Roger Y Wong¹^,4 and William C Miller²^,3^,4

¹Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Canada

²Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada

³GF Strong Rehabilitation Research Laboratory, Vancouver, British Columbia, Canada

⁴Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada

author email corresponding author email

BMC Geriatrics 2008, 8:10doi:10.1186/1471-2318-8-10


Published:	14 May 2008

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.