Abstract
BackgroundFew data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient.MethodsA retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over 6 years (2012–2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital’s electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome.ResultsA total of 139,130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes.When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p < 0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p < 0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p < 0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p = 0.523).ConclusionDiabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.
Highlights
Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years
Diabetes mellitus is common in developed western nations, with 30 million people diagnosed with diabetes in the United States (US) in 2015 [1], and prevalence of 6 and 5.4% in the United Kingdom (UK) and Australia, respectively [2]
Study design A retrospective study was conducted of patients aged 65 years and older admitted for 24 h or more for acute care in the South East Sydney Local Health District (SESL HD) over 76 months, from 1 July 2012 to 30 September 2018
Summary
Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. Diabetes mellitus is common in developed western nations, with 30 million people diagnosed with diabetes (prevalence 9.4%) in the US in 2015 [1], and prevalence of 6 and 5.4% in the UK and Australia, respectively [2]. Diabetes UK reports increased cardiovascular, renal, ophthalmic, peripheral vascular, Hospitalisation in people with diabetes is more likely, more frequent, and with a longer length of stay [5,6,7]. Ageing is strongly associated with the development of diabetes [10]. The prevalence of diabetes increases with age, with 3–5 times the prevalence of diabetes in people over aged 65 years [1, 2]
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