There is no mortality prediction index for Chinese nursing home older residents. The objective of this study was to derive and validate a 2-year mortality prognostic index for them.
We carried out a prospective cohort study on 1120 older residents from 12 nursing homes of Hong Kong. We obtained potential predictors of mortality and carried out updated functional assessment. Each risk factor associated independently with 2-year mortality in a derivation cohort was assigned a score based on the odds ratio, and risk scores were calculated for each participant by adding the points of risk factors present. Similar analysis was carried out on the validation cohort.
Independent predictors of mortality included: aged 86-90 years (3 points); aged ≥ 91 years (4 points); Charlson comorbidity index ≥ 4 (6 points); Barthel Index 5-60 (5 points); Barthel Index 0 (10 points); number of hospitalizations in the preceding year (Adbefore) 1 (4 points); Adbefore 2 (5 points) and Adbefore ≥ 3 (6 points). In the derivation cohort, 2-year mortality was 10.8% in the low-risk group (≤ 4 points) and 59.9% in the high-risk group (≥ 14 points). In the validation cohort, 2-year mortality was 11.8% in the low-risk group and 60.4% in the high-risk group. The receiver-operator characteristic curve area was 0.761 for the derivation cohort and 0.742 for the validation cohort.
Our prognostic index had satisfactory discrimination and calibration in an independent sample of Chinese nursing home older residents. It can be used to identify older residents with a high risk for poor outcomes, who need a different level of care.
[Show abstract][Hide abstract] ABSTRACT: Aim: To identify predictors of negative in-patient outcomes (prolonged hospital stay and death) in nursing home (NH) residents admitted to the hospital as medical emergencies.
Methods: This was a retrospective patient series set at St James's Hospital (Dublin, Ireland). The participants were all NH patients requiring acute medical admission under the on-call medical team between 1 January 2002 and 31 December 2010. Patient characteristics on admission, such as demographics, comorbidity level, major diagnostic categories, vital signs and laboratory profile, were measured. The outcomes of the study were prolonged hospital stay (≥30 days) and in-hospital mortality. The characteristics of NH patients were compared with those of non-NH patients aged ≥65 years. Multivariate analyses were based on generalized estimating equations and classification trees.
Results: There were 55 763 acute medical admissions over the period, of which 1938 (3.5%) were from NH. As compared with non-NH patients aged ≥65 years, NH patients had greater acute illness severity. NH patients had a median length of stay of 7 days, and 17% had a prolonged admission. Their overall mortality rate was 23%. However, the classification analysis showed substantial patient heterogeneity; the subgroup with the highest mortality (54%, n = 100) had positive serum troponin and a respiratory major diagnosis. The lowest mortality rate (4%) was seen in those without positive troponin, urea of 12 mmol/L or less, and albumin of more than 37 mg/L (n = 226).
Conclusions: Simple serum markers, such as troponin, urea and albumin, might predict mortality in medically admitted NH patients. This might help health-care practitioners to anticipate their clinical course at an early stage. Geriatr Gerontol Int 2012; ••: ••–••.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To investigate chronic kidney disease (CKD) as a predictor of mortality and hospitalization in Chinese nursing homes older residents. DESIGN: A 3-year prospective multicenter cohort study. SETTING: Nine nursing homes in Hong Kong. PARTICIPANTS: Nursing home older adults (812 total; 271 men and 571 women), mean age 86.0 ± 7.6. MEASUREMENTS: Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study (Chinese-adjusted), and participants were stratified into different severity of renal impairment according to the modified version of Kidney Disease Outcomes Quality Initiative (K/DOQI): stage 1 CKD: GFR > 90 mL/min/1.73 m(2); stage 2 CKD: 60-89 mL/min/1.73 m(2); stage 3A CKD: 45-59 mL/min/1.73 m(2); stage 3B CKD: 30-44 mL/min/1.73m(2); stage 4/5: <30 mL/min/1.73 m(2). The outcome measures were the all-cause, infection-related, and cardiovascular-related mortality and hospitalizations. RESULTS: Older adults with stage 3B and stage 4/5 CKD had higher all-cause, infection-related, and cardiovascular-related mortality than those with earlier stages of CKD. After multivariate analysis, stage 3B and stage 4/5 CKD were independent predictors of all-cause mortality (stage 3B, hazard ratio [HR]: 1.62, 95% CI: 1.12-2.33, P = .01; stage 4/5, HR: 2.00, 95% CI: 1.34-3.00, P = .001) and infection-related mortality (stage 3B, HR: 1.41, 95% CI: 1.08-2.30, P = .019; stage 4/5, HR: 1.91, 95% CI: 1.13-3.23, P = .016), but not cardiovascular-related mortalities. The all-cause, infection-related, and cardiovascular-related hospitalizations were significantly higher in older nursing home adults with stage 3B and stage 4/5 CKD. CONCLUSION: In Chinese nursing home older adults, stage 3B and stage 4/5 CKD are independent predictors of all-cause and infection-related mortality. They also predict increased risks of all-cause, infection-related, and cardiovascular-related hospitalizations.
Journal of the American Medical Directors Association 09/2012; 13(9). DOI:10.1016/j.jamda.2012.08.006 · 4.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim: There is little data regarding the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. The objective of this study was to investigate the prevalence and associated comorbidities of anemia in Chinese nursing home older adults.
Methods: We carried out a retrospective cross-sectional study in nine nursing homes in Hong Kong. The hemoglobin (Hb) level, mean corpuscular volume (MCV), serum creatinine and comorbidities data of residents were examined. Older adults were regarded as anemic according to the World Health Organization criteria (Hb <13g/dL for men and <12g/dL for women). The glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD [Chinese-adjusted]) equation. Patients with chronic renal impairment were defined as having eGFR <60 mL/min/1.73 m2.
Results: A total of 812 residents were included (mean age 86.0 ± 7.6 years). The mean hemoglobin was 12.0 ± 1.8g/dL in men and 11.4 ± 1.6g/dL in women. The mean eGFR was 75.1 ± 31.7 mL/min/1.73 m2. A total of 67.0% of residents had anemia (70.5% in men and 65.2% in women). Anemic older adults were older and had a higher prevalence of renal impairment than non-anemic older adults (P < 0.001). There was no significant difference between the two groups regarding the prevalence of other comorbidities. When stratified into different age groups, there were significant correlations between anemia and renal impairment in all subgroups (age ≤80 years, P < 0.05; age 81–90 years, P < 0.01; age >90 years, P < 0.05). The same correlation was found between normocytic anemia and renal impairment. Conversely, when stratified according to eGFR (≥60 mL/min/1.73 m2vs <60 mL/min/1.73 m2), we did not observe a significant correlation between anemia and age group.
Conclusion: In conclusion, anemia is prevalent in Chinese nursing home residents and is strongly associated with renal impairment. Further studies of early identification and management of anemia with renal impairment are recommended in this population. Geriatr Gerontol Int 2013; 13: 591–596.
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