Abstract
Background: Hospitalized older patients are particularly exposed to adverse health outcomes.Objective: In this study, we aimed at investigating the prognostic interactions between disability in basic activities of daily living (BADL), cognitive impairment, low handgrip strength, anticholinergic cognitive burden (ACB), and depression on 1-year mortality.Setting and Subjects: Our series consisted of 503 older patients discharged from acute care hospitals.Methods: Disability in at least one BADL, ACB, depression, cognitive impairment, and low handgrip strength was considered in the analysis. One-year mortality was investigated by Cox regression analysis and prognostic interactions among study variables were assessed by survival tree analysis.Results: Basic activities of daily living disability, ACB, cognitive impairment, and low handgrip strength were significantly associated with 1-year mortality. Survival tree analysis showed that patients with BADL disability and high ACB carried the highest risk of poor survival [hazard ratio (HR): 16.48 (2.63–74.72)], followed by patients with BADL disability and low ACB (HR: 8.43, 95% CI: 1.85–38.87). Patients with cognitive impairment and no BADL disability were characterized by a lower but still significant risk of mortality (HR: 6.61, 95% CI: 1.51–28.97) and those with high ACB scores and good cognitive and functional performance (HR: 5.28, 95% CI: 1.13–24.55).Conclusion: Basic activities of daily living dependency, cognitive impairment, and ACB score were the three main predictors of 1-year mortality among patients discharged from acute care hospitals; the interaction between BADL dependency and ACB score wasfound to significantly affect survival. Early identification of such high-risk patients may help tailor targeted interventions to counteract their detrimental effects on prognosis.
Highlights
IntroductionHospitalized older individuals represent a complex and extremely heterogeneous portion of the geriatric population, exposed to a constant burden associated with multimorbidity, polypharmacy, and acute diseases, which may affect the overall quality of life and prognosis [1, 2]
Hospitalized older individuals represent a complex and extremely heterogeneous portion of the geriatric population, exposed to a constant burden associated with multimorbidity, polypharmacy, and acute diseases, which may affect the overall quality of life and prognosis [1, 2].Several prospective studies have identified multiple predictors of increased risk of death in this population [3, 4]
Cox regression analysis showed that all study risk factors but depression were associated with increased 1-year mortality in age- and sex-adjusted models, and similar findings were obtained in models B and C after adjusting for potential confounders (Table 2)
Summary
Hospitalized older individuals represent a complex and extremely heterogeneous portion of the geriatric population, exposed to a constant burden associated with multimorbidity, polypharmacy, and acute diseases, which may affect the overall quality of life and prognosis [1, 2]. Several prospective studies have identified multiple predictors of increased risk of death in this population [3, 4]. Cognitive impairment is a well-known predictor of poor outcomes in geriatric populations, in terms of mortality [7]. Medication burden was associated with increased mortality [13], and exposure to anticholinergic medications is an important predictor of poor outcomes among hospitalized older patients [14,15,16,17]. Hospitalized older patients are exposed to adverse health outcomes
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