Six-month outcome of elderly people hospitalized via the emergency department: The SAFES cohort

Abstract

BackgroundThe objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization. MethodsA prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period. ResultsCrude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR=1.83; 95% CI=1.27–2.62) or a higher number of children (HR=0.86; 95% CI=0.78–0.96), balance problems (HR=1.72; 95% CI=1.19–2.47), malnutrition or risk thereof (HR=1.93; 95% CI=1.24–3.01), and dementia syndrome (HR=1.88; 95% CI=1.32–2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR=1.92; 95% CI=1.17–3.16), delirium (HR=1.80; 95% CI=1.24–2.62), and a high level of comorbidity (HR=1.62; 95% CI=1.09–2.40). Institutionalization (HR=1.92; 95% CI=1.37–2.71) and unplanned readmission (HR=4.47; 95% CI=3.16–2.71) within the follow-up period were also found as independent predictors. ConclusionThe main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects’ prognosis favorably.