1-year Mortality In Elderly Patients Research Articles

Risk factors for 1-year mortality in elderly patients after intertrochanteric fracture surgery: a retrospective study of 1854 cases

Objective To investigate the risk factors for 1-year mortality in the elderly patients following intertrochanteric fracture surgery.Methods A retrospective study was conducted to analyze the elderly 1854 patients who had been treated for intertrochanteric fracture from August 2005 to August 2011 in 6 hospitals in Hangzhou district and completed their follow-ups.They were 1149 females and 705 males,aged from 65 to 98 years (average,79.4 years).Their 1-year mortality and causes were documented.Logistic Regression was used to analyze the risk factors associated with their 1-year mortality.Results Altogether 297 patients died within one year after surgery,giving a mortality of 16.0％ (297/1854).The causes included infection in 93 cases,heart attack in 38,nervous system disease in 53,and tumor in 63.Logistic Regression analyses found advanced age [OR=5.053,95％ CI (1.517,16.829),P =0.000],gender [OR=0.376,95％ CI (0.122,1.161),P=0.002],number ofcomorbidities [OR=3.236,95％ CI (1.553,6.746),P =0.001],ASA (American Society of Anaesthesiologists) score [OR =6.057,95％ CI (1.968,18.641),P =0.000],delay in surgery [OR =1.928,95％ CI (0.979,3.796),P =0.009] and length of hospital stay [OR =3.875,95％ CI (0.368,6.542),P =0.001] to be independent risk factors significantly associated with the 1-year mortality.Conclusion Advanced age,gender,ASA score,number of comorbidities,delay in surgery and length of hospital stay may be the independent risk factors for 1-year mortality in the elderly patients following intertrochanteric fracture surgery. Key words: Hip fractures; Mortality; Risk factor; Aged

CORR Insights®: Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

This CORR Insights®is a commentary on the article “Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?” by Raspopovic and colleagues, available at DOI 10.1007/s11999-013-2955-1. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. This CORR Insights® comment refers to the article available at DOI 10.1007/s11999-013-2955-1.

Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.

Depressive symptoms and one year mortality among elderly patients discharged from a rehabilitation ward after orthopaedic surgery of the lower limbs.

The objective of the present prospective observational study is to evaluate the effect of depressive symptoms on 1-year mortality in a population of elderly patients discharged from a rehabilitation unit after orthopaedic surgery of the lower limbs. A total of 222 elderly inpatients were included, and stratified according to 12-months survival. 14 (6.3%) of the patients who were eligible for this study died during the 12-months period after discharge. As expected, patients who died were significantly older, lower cognitive performance, more depressive symptoms, poorer nutritional status and higher comorbidity in comparison to those who survived. Furthermore, they were generally more functionally dependent on admission to the Department, had worse functional recovery and were more disable at discharge, although a longer length of stay comparing to survived patients. In the adjusted logistic regression model, after adjustment for possible confounders and covariates, the presence of severe depressive symptoms significantly predicted a four-fold risk of death at 12 months. The only other factor associated poor 12-months survival was comorbidity, that predicted a 6-fold risk of death. In conclusions this study suggests that severe depressive symptoms on admission predicts 1-year mortality in elderly patients discharged from a post-acute care unit after orthopaedic rehabilitation.

Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: Data from a large nationwide cardiology database (IN-CHF Registry)

Background Congestive heart failure (HF) represents a major public health problem with an age-related increasing prevalence. Despite the high mortality and morbidity in elderly patients with HF, limited clinical and prognostic data are available for development of appropriate prevention and treatment strategies. Methods A cohort of 3327 outpatients consecutively enrolled in the Registry of Italian Network on Congestive Heart Failure by 133 cardiology centers was studied. Univariate and multivariate analyses were performed to compare patients <70 and ≥70 years old and to evaluate associations between clinical variables and the 1-year mortality rate and hospitalizations. Results With respect to the 2294 patients <70 years old, the 1033 (31%) elderly patients were significantly more likely to be female, to be in New York Heart Association (NYHA) class III-IV, and to have preserved left ventricular systolic function (ejection fraction >40%), an ischemic/valvular etiology, and atrial fibrillation/flutter. Elderly patients received angiotensin-converting enzyme inhibitors, β-blockers, and anticoagulants less frequently than younger patients did. The 1-year mortality rate was significantly higher in patients ≥70 years old (22% vs 13.7%, P <.001). Age was an independent predictor of 1-year mortality, increasing 2.8% by each year of age. Independent predictors of 1-year mortality in elderly patients were (1) ≥1 hospital admission in the previous year (relative risk [RR] 2.09, 95% CI 1.51-2.87), (2) systolic blood pressure (RR 0.98, 95% CI 0.97-0.99), (3) NYHA class III-IV (RR 1.57, 95% CI 1.20-2.07), and (4) age (RR 1.028, 95% CI 1.001-1.056). Conclusions Our study confirms that elderly patients (1) are seen in a more advanced stage of HF, (2) are less likely to receive evidence-based treatments, (3) show more frequently preserved systolic function, and (4) have a worse prognosis. Consequently, there is a need to develop more effective and targeted management strategies for this escalating health problem. (Am Heart J 2002;143:45-55.)

Prognostic markers in older patients starting renal replacement therapy

We assessed all patients starting renal replacement therapy during a 1-year period to identify factors influencing 1-year survival in older and younger dialysis patients. Data was collected from 113 patients. Twenty-four possible prognostic factors were introduced into a multivariate, time-based analysis. Hazard ratios, and hence risk of mortality, were increased with increasing alcohol consumption, cardiac dyskinesis, age at onset of dialysis, serum phosphate, number of comorbid illnesses, and Karnofsky score (listed in decreasing order of risk). Risk of death within 1 year was reduced in patients with normal serum albumin and higher Barthel scores at the time of commencing dialysis. No age interactions were found. In the elderly age group the risk of death was also increased if left ventricular dilatation was present. Comorbidity and the age of onset were not independent risk factors in patients aged over 65 years at the time of starting dialysis. All factors listed above increase the 1-year mortality of elderly patients. Factors known to increase medium-term morbidity in dialysis patients including diabetes mellitus, ischaemic heart disease, and hypertension do not appear to be important in the short-term survival of older patient on dialysis.