Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care

Abstract

To determine the association between functional and nutritional changes caused by an acute illness requiring hospitalisation and 6-month mortality. Hospital-based prospective longitudinal cohort study. Acute care centre (Hospital General de Vic, Barcelona Province, Spain). Post-acute care centre (Hospital de la Santa Creu de Vic, Barcelona Province, Spain). Hundred sixty five patients aged 75 years and older, hospitalised for an acute event. Functional status (Barthel and Lawton Indices), cognitive status (Short Portable Mental Status Questionnaire), nutritional status (Mini Nutritional Assessment, albumin, cholesterol), depressive symptoms (Geriatric Depression Scale), co-morbidity (Charlson Index) and self-rated health status were collected upon admission to the post-acute care centre. Functional and nutritional status were assessed 1, 3 and 6 months after admission by a trained staff of geriatricians. Six-month mortality was the main outcome variable. Survival analysis was performed with functional and nutritional status as time-dependent variables. The mean age of the cohort was 83.3 years (SD 5.1) and 68.5% were female. Six-month mortality was 29.1% (95% CI: 22.2-36.7). The variables associated with mortality in bivariate analysis were: gender, Barthel Index (2 weeks before admission), Lawton Index (2 weeks before admission), Charlson Index, Barthel Index (time-dependent), Mini Nutritional Assessment (MNA) (time-dependent) and cognitive status. The variables associated with mortality in multivariate analysis were: gender, Barthel Index (2 weeks before admission), Charlson Index and MNA (time-dependent). Functional and nutritional changes due to an acute illness have a statistical and clinical prognostic value and should be assessed along with other well-known relevant prognostic factors.