Prognostic stratification of older patients with complex medical problems among those who access the emergency department (ED) may improve the effectiveness of geriatric interventions. Whether such targeting can be performed through simple administrative data is unknown.
We examined the discharge records for 10,913 patients aged 75 years or older admitted during 2005 to the ED of all public hospitals in Florence, Italy. Using information on demographics, drug treatment, previous hospital admissions, and discharge diagnoses, we developed a 1-year mortality prognostic index. The predictive validity of this index was tested in a subsample of patients independent of the subsample used for its original development. Finally, we tested whether patients stratified by the prognostic index had different mortality when admitted to a geriatrics compared with an internal medicine ward.
In the validation subsample, patients with scores of 4-6, 7-10, and 11+ compared with those with scores less than 4 had hazard ratios (95% confidence interval) for 1-year mortality of, respectively, 1.5 (1.3-1.7), 2.2 (1.3-1.7), and 3.0 (2.6-3.4). Patients in the worse prognostic stratum experienced 33% higher mortality when admitted to an internal medicine compared with a geriatrics ward, although mortality was not significantly affected by the type of ward of admission in all other risk strata.
Simple administrative data provide prognostic information on long-term mortality in older patients hospitalized via ED. Patients with worse prognostic index scores appear to benefit from admission in a geriatrics compared with an internal medicine ward.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/2009; 65(2):159-64. DOI:10.1093/gerona/glp043 · 4.31 Impact Factor
To assess the relationship between office and ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) and total mortality in elderly patients with hypertension.
Observational prospective cohort study.
Hypertension outpatient clinic in a geriatric academic hospital.
Eight hundred five older (> or =60) subjects with hypertension underwent office and ambulatory BP measurement. Mortality was assessed after a mean follow-up of 3.8 years.
In a total of 3,090 person-years of follow-up, 107 participants died (average mortality rate 3.5% per year). With bivariate analysis, participants who died had higher SBP and PP and lower DBP, with office and ambulatory measurements. Mortality rates were greater with higher SBP and lower with higher DBP. As a combined effect of these trends, PP was associated with the widest death rate gradients, from 12 to 66, 13 to 63, and 9 to 70 per 1,000 person-years across office, 24-hour, daytime, and nighttime PP quartiles, respectively. Multivariate Cox analysis confirmed these trends; the adjusted hazard of death increased linearly with increasing ambulatory SBP and PP, whereas it decreased significantly with increasing ambulatory DBP. A five times greater risk of death was detected when comparing night-time PP quartile 4 (median PP value 78 mmHg) with quartile 1 (median PP value 46 mmHg).
In older patients with hypertension, low DBP and high PP, particularly when measured using ambulatory BP monitoring, are associated with greater risk of death. The achievement of an SBP treatment goal should not be obtained at the expense of an excessive DBP reduction.
Journal of the American Geriatrics Society 03/2009; 57(2):291-6. DOI:10.1111/j.1532-5415.2008.02123.x · 4.22 Impact Factor
To assess the incidence and prognostic value of hypoglycemia in hospitalized non-diabetic elderly patients.
An observational retrospective study, with a 3-year follow-up, was performed in a series of 678 patients aged over 65 years, admitted between January 1 2001 and December 31 2001 to the Units of Gerontology and Geriatrics of the Careggi University Hospital, Florence, Italy. Patients with diabetes mellitus were excluded. To determine the cumulative incidence of hypoglycemia, all measurements of venous or capillary blood glucose during hospital stay were taken into account. In-hospital mortality was determined from hospital discharge records. Information on all-cause, three-year mortality after hospital admission was obtained from the City of Florence Registry Office.
Hypoglycemia was observed in 8.6% of patients, and was asymptomatic in about 25% of cases. In-hospital mortality was significantly higher in patients with hypoglycemia (41.4% vs 14.3%; p<0.001), even after adjustment for potential confounders, including comorbidity, indices of malnutrition, and pharmacological treatment (adjusted OR 2.17[1.25;3.85]). 3-year mortality was significantly higher in patients with hypoglycemia during hospital stay, but the difference was not significant after adjustment for confounders.
Hypoglycemia is a prognostic marker of in-hospital mortality in non-diabetic hospitalized patients, even after adjustment for comorbidity and indices of malnutrition. Instead, it does not seem to have any relevant independent prognostic value in the longer term.
Aging clinical and experimental research 11/2006; 18(5):446-51. DOI:10.1007/BF03324842 · 1.14 Impact Factor