Περίληψη:
Objectives: to examine the relationship between seven predictor
variables (recorded on Day 3 of hospital admission) and discharge
destination in non-elective medical patients aged 65+ years.
Design: prospective cohort.
Setting: eight centres in six European countries.
Predictor variables: age, gender, living alone, physical function (three
categories based on Barthel Index), cognition (Katzman’s
orientation-memory-concentration test), main body system affected (based
on International Classification of Diseases), number of geriatric giants
(GGs) involved in the referral (a GG being a problem with falling,
mobility, continence or cognition).
Main outcome measures: discharge destination (by Day 90) in three
categories: ‘HOMESAME’ (return to previous residence), ‘INSTIN90’
(discharge to alternative residence or still in hospital at 90 days),
‘DEADINHO’ (death in hospital),
Results: in 1,626 patients, discharge destination was HOMESAME in
84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay
was 17.7 days, median 12. Univariate analyses showed a statistically
significant relationship between all seven predictor variables and
discharge destination. Physical function was the best single predictor
with a sevenfold difference in adverse outcome rates between the best
and worst categories. On multiple logistic regression, significant
predictor variables were as follows. (i) For DEADINHO: physical
function, cognition, gender; (ii) for INSTIN90: physical function,
living alone, GGs, age, gender. Multiple linear regression identified
physical function, GGs and living alone as predictors of log, length of
stay.
Conclusion: case-mix systems to compare risk-adjusted hospital outcome
in older medical patients need to incorporate information about physical
function, cognition and presenting problems in addition to diagnosis.
Συγγραφείς:
Campbell, SE
Seymour, DG
Primrose, WR
Lynch, JE
Dunstan,
E
Espallargues, M
Lamura, G
Lawson, P
Philp, I and
Mestheneos, E
Politynska, B
Raiha, I
ACMEplus Project Team
