Journals of Gerontology Series A: Biological Sciences and Medical Sciences Large Type Edition
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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M1049-M1054 (2003)
© 2003 The Gerontological Society of America

Risk Factors for Early and Late Mortality in Hospitalized Older Patients: The Continuing Importance of Functional Status

Maria Ponzetto1, Barbara Maero1, Paola Maina1, Rosalba Rosato2, Giovannino Ciccone2, Franco Merletti2, Laurence Z. Rubenstein3 and Fabrizio Fabris1

1 Medical and Surgical Department, Geriatric Section, University of Torino, Italy.
2 Unit of Cancer Epidemiology, University of Torino and CPO Piemonte, Italy.
3 Sepulveda Veterans Affairs Medical Center, California.

Background. Prognostic information collected at hospital admission may be useful in defining care objectives and in deciding on therapy for older people. The aim of our study was to identify admission risk factors for in-hospital and postdischarge mortality.

Methods. The study included 987 patients aged 70 years and older admitted to the geriatric ward of San Giovanni Battista Hospital in Torino during 1995 and 1996. Demographic, clinical, and functional variables were collected on admission to hospital and examined as potential risk factors for mortality during hospitalization and at 5 years of follow-up.

Results. During their hospital stay, 147 patients (14.9%) died. Risk factors independently associated with in-hospital mortality included functional impairment (Activities of Daily Living [ADL]) (OR [odds ratio] 1.73, CI [confidence interval] 95% 1.02–2.95), dependence related to medical conditions (OR 2.18, CI 95% 1.39–3.42), cerebrovascular disease (OR 3.23, CI 95% 1.64–6.37), cancer (OR 4.52, CI 95% 1.99–10.24), albumin 3.0–3.4 g/dl (OR 4.51, CI 95% 2.76–7.35), albumin <3.0 g/dl (OR 6.83, CI 95% 3.59–13.0), creatinine 1.5–3 mg/dl (OR 2.23, CI 95% 1.36–3.65), creatinine >3 mg/dl (OR 2.55, CI 95% 1.10–5.93), and fibrinogen >=452 mg/dl (OR 1.91, CI 95% 1.26–2.89). During the 5-year follow-up, 553 patients (67.7%) died. Variables independently associated with mortality in multivariate analysis were age 75–84 years (HR [hazard ratio] 1.40, CI 95% 1.10–1.78), >=85 years (HR 2.08, CI 95% 1.59–2.72), male sex (HR 1.50, CI 95% 1.24–1.81), ADL dependency (HR 1.24, CI 95% 1.01–1.52), >=5 errors on Short Portable Mental Status Questionnaire (HR 1.34, CI 95% 1.10–1.63), dependence on Dependence Medical Index (HR 1.36, CI 95% 1.10–1.67), presence of cancer (HR 2.58, CI 95% 1.80–3.71), hemoglobin <=11 g/dl (HR 1.46, CI 95% 1.17–1.81), and Charlson's Index >=2 (HR 1.49, CI 95% 1.14–1.95).

Conclusions. A complete functional and clinical evaluation at hospital admission permits identification of patients at higher risk of early and long-term mortality.






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