Early Indicators of Prolonged Hospitalization of the Elderly: Pilot Study at Strasbourg University Hospital
From: Département de Réhabilitation et Gériatrie, Hôpital des Trois-Chêne, Hôpitaux universitaires de Genève, Thonex-Genève, Suisse. Pierre.O.Lang@hcuge.ch
Presse médicale (Paris, France : 1983)
- Publish Date: Mar 2007
- ISSN: 0755-4982
- Volume: 36
- Issue: 3 Pt 1
- Pages: 389-98
- Medium: Print
- Language:
- Citation (JAMA): Lang Pierre-Olivier, Heitz Damien, Meyer Nicolas, et al. Early Indicators of Prolonged Hospitalization of the Elderly: Pilot Study at Strasbourg University Hospital. Mar 2007;36:389-98
Abstract
OBJECTIVES: The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients. METHODS: This prospective pilot study, conducted at Strasbourg University Hospital, included patients aged 75 years or older who were hospitalized via the emergency department (SAFES cohort: Sujet Agé Fragile: Evaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG). RESULTS: The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with a mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A “risk of malnutrition” (OR=14.07) and “mood disorders” (OR=2,5) were both early markers for prolonged hospitalization. Although not statistically significant, “walking difficulties” (OR=2.72) and “cognitive impairment” (OR=5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz’s Activities of Daily Living Index or its course during hospitalization. CONCLUSION: Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.
Mesh Headings (Keywords): Age Factors, Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Diagnosis-Related Groups, Female, Follow-Up Studies, Frail Elderly, Geriatric Assessment, Humans, Length of Stay, Logistic Models, Male, Pilot Projects, Prospective Studies, Risk Factors, Sex Factors, Socioeconomic Factors, Walking
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