Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals |
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| Authors: | Lang Pierre-Olivier Heitz Damien Hédelin Guy Dramé Moustapha Jovenin Nicolas Ankri Joël Somme Dominique Novella Jean-Luc Gauvain Jean Bernard Couturier Pascal Voisin Thierry De Wazière Benoît Gonthier Régis Jeandel Claude Jolly Damien Saint-Jean Olivier Blanchard François |
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| Institution: | From the
*Department of Internal Geriatric Medicine, H?pital de la Robertsau, CHRU de Strasbourg, Strasbourg, France?Laboratory of Epidemiology and Public Health, School of Medicine, Université de Strasbourg, Strasbourg, France?School of Medicine, Université de Reims Champagne‐Ardenne, E.A. 3797, Reims, France§Internal Medicine Unit and Geriatric Clinic, H?pital Sébastopol, and ∥Methodological Assistance Unit, Department of Medical Information, H?pital Maison Blanche, CHU de Reims, Reims, France?Center of Gerontology, H?pital Sainte Perrine, and #Division of Geriatrics, H?pital Européen G. Pompidou, Assistance Publique—H?pitaux de Paris, Paris, France**Center for Geriatric Medicine, H?pital Porte Madeleine, CHR d'Orléans, Orléans, France??Geriatric Unit, H?pital de la Tronche, CHU de Grenoble, Grenoble, France??Internal Medicine Unit and Gerontology Clinic, H?pital Rangueil, CHU de Toulouse, Toulouse, France§§Internal Medicine and Geriatrics Unit, H?pital Gaston Doumergues, CHU de N?mes, N?mes, France∥∥Gerontology Clinic, H?pital de la Charité, CHU de Saint étienne, Saint étienne, France??Gerontology Clinic, H?pital la Colombière, CHU de Montpellier, Montpellier, France. |
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| Abstract: | OBJECTIVES: To identify early markers of prolonged hospital stays in older people in acute hospitals. DESIGN: A prospective, multicenter study. SETTING: Nine hospitals in France. PARTICIPANTS: One thousand three hundred six patients aged 75 and older were hospitalized through an emergency department (Sujet Agé Fragile: Evaluation et suivi (SAFEs)--Frail Elderly Subjects: Evaluation and follow-up). MEASUREMENTS: Data used in a logistic regression were obtained through a gerontological evaluation of inpatients, conducted in the first week of hospitalization. The center effect was considered in two models as a random and fixed effect. Two limits were used to define a prolonged hospital stay. The first was fixed at 30 days. The second was adjusted for Diagnosis Related Groups according to the French classification (f-DRG). RESULTS: Nine hundred eight of the 1,306 hospital stays that made up the cohort were analyzed. Two centers (n=298) were excluded because of a large volume of missing f-DRGs. Two-thirds of subjects in the cohort analyzed were women (64%), with a mean age of 84. One hundred thirty-eight stays (15%) lasted more than 30 days; 46 (5%) were prolonged beyond the f-DRG-adjusted limit. No sociodemographic variables seemed to influence the length of stay, regardless of the limit used. For the 30-day limit, only cognitive impairment (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.2-4.0) was identified as a marker for prolongation. f-DRG adjustment revealed other clinical markers. Walking difficulties (OR=2.6, 95% CI=1.2-16.7), fall risk (OR=2.5, 95% CI=1.7-5.3), cognitive impairment (OR=7.1, 95% CI=2.3-49.9), and malnutrition risk (OR=2.5, 95% CI=1.7-19.6) were found to be early markers for prolonged stays, although dependence level and its evolution, estimated using the Katz activity of daily living (ADL) index, were not identified as risk factors. CONCLUSION: When the generally recognized parameters of frailty are taken into account, a set of simple items (walking difficulties, risk of fall, risk of malnutrition, and cognitive impairment) enables a predictive approach to the length of stay of elderly patients hospitalized under emergency circumstances. Katz ADLs were not among the early markers identified. |
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| Keywords: | early markers prolonged stays frail elderly people SAFEs cohort |
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