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1 Medical Unit for the Acute Care of the Elderly, Poliambulanza Hospital, and Geriatric Research Group, Brescia, Italy.
2 Laboratory of Epidemiology & Neuroimaging, IRCCS S Giovanni di Dio–FBF, Brescia, Italy, and AfaR–Associazione Fatebenefratelli per la Ricerca, Rome, Italy.
Address correspondence to Renzo Rozzini, Geriatric Research Group, via Romanino 1, 25122 Brescia, Italy. E-mail: renzo.rozzini{at}iol.it
Objective. This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death.
Methods. Nine hundred fifty elderly ambulant patients (F = 69.3%; mean age 78.3 ± 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable.
Results. Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination < 18), APACHE–Acute Physiology Score , albumin level <3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [<30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6–3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3–5.7).
Conclusions. Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.
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