Original Article| Volume 26, ISSUE 9, P705-708, November 2015

Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness

Published:August 26, 2015DOI:


      • Nonagenarians are a growing group different from younger population.
      • To know nonagenarians' mortality risk factors after discharge is very important.
      • Age, previous BI, and functional loss are the risk factors a month after admission.
      • One year after hypoalbuminemia and functional loss are the main risk factors.



      To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions.

      Design, Setting, and Participants

      Prospective study of all patients aged 90 years or older admitted in a geriatric unit during 2009 due to medical acute illness. Baseline variables were collected at admission (sex, cause of admission, Charlson index, serum albumin, functional, and mental status), functional loss at admission (as the difference between Barthel index(BI) 2 weeks before admission and BI at admission), and functional loss at discharge(as the difference between BI 2 weeks before admission and BI at discharge). The association of these variables with mortality at 1 month and 1 year after admission was analyzed by multivariate Cox regression analysis.


      Out of all patients admitted, 434 (33%) were 90 years old or older and 76.3% were female. Mortality at 1 month and 1 year after admission was 19% and 57%, respectively. In the month mortality multivariate analysis, being older (HR, 1.11; 95% CI = 1.02 to 1.20), a previous Barthel index less than 40 points (HR, 5.87; 95% CI = 1.16 to 29.67), and functional loss at admission (HR; 1.13; 95% CI = 1.03 to 1.25) were independent risk factors. When patients that died 1 month after admission were excluded, the presence of hypoalbuminemia <3 g/dl (HR, 2.70; 95% CI = 1.69 to 4.32) and functional loss at discharge (HR-1.08, 95% CI = 1.03 to 1.14) were the factors associated with 1 year mortality.


      In nonagenarians, functional impairment is the most important risk factor associated with short and long-term mortality after hospitalization due to acute medical illness.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lázaro M.
        • Marco J.
        • Barba R.
        • Ribera J.M.
        • Plaza S.
        • Zapatero A.
        Nonagenarian patients admitted to Spanish Internal Medicine Hospital.
        Rev Esp Geriatr Gerontol. 2012; 47: 193-197
        • Barba R.
        • Martínez J.M.
        • Zapatero A.
        • Plaza S.
        • Losa J.E.
        • Canora J.
        • García de Casasola G.
        • et al.
        Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain.
        Eur J Intern Med. 2011; 22: 49-52
        • Covinsky K.E.
        • Palmer R.M.
        • Fortinsky R.H.
        • Counsell S.R.
        • Stewart A.L.
        • Kresevic D.
        • et al.
        Loss of independence in activities of daily living in older adults with medical illnesses: increased vulnerability with age.
        J Am Geriatr Soc. 2003; 51: 451-458
        • Formiga F.
        • López Soto A.
        • Sacanella E.
        • Jacob X.
        • Masanés F.
        • Vidal M.
        Evaluation of functional capability after hospital admission of nonagenarians.
        Med Clin (Barc). 2000; 115: 695-696
        • Sepúlveda D.
        • Isach M.
        • Izquierdo G.
        • Ruipérez I.
        Functional decline in nonagenarians admitted at acute care hospitals.
        Med Clin (Barc). 2001; 116: 799
        • Conde-Martel A.
        • Hemmersbach-Miller M.
        • Marchena-Gomez J.
        • Saavedra-Santana P.
        • Betancor-Leon P.
        Five-year survival and prognostic factors in a cohort of hospitalized nonagenarians.
        Eur J Intern Med. 2012; 23: 513-518
        • Charlson M.E.
        • Pompei P.
        • Ales K.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Kubota K1.
        • Kadomura T.
        • Ohta K.
        • Koyama K.
        • Okuda H.
        • Kobayashi M.
        • et al.
        Analyses of laboratory data and establishment of reference values and intervals for healthy elderly people.
        J Nutr Health Aging. 2012; 16: 412-416
        • Shah S.
        • Vanclay F.
        • Cooper B.
        Improving the sensitivity of Barthel index for stroke rehabilitation.
        J Clin Epidemiol. 1989; 42: 703-709
        • Baztán J.J.
        • González M.
        • Morales C.
        • Vázquez E.
        • Morón N.
        • Forcano S.
        • et al.
        Variables associated with functional recovery and post-discharge institutionalization of elderly cared in an average stay geriatric unit.
        Rev Clin Esp. 2004; 204: 574-582
        • Valderrama Gama E.
        • Damián J.
        • Guallar E.
        • Rodríguez Mañas L.
        Previous disability as a predictor of outcome in a geriatric rehabilitation unit.
        J Gerontol. 1998; 53A: M405-M409
        • Palleschi L.
        • De alfieri W.
        • Salani B.
        • et al.
        Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study.
        J Am Geriatr Soc. 2011; 59: 193-199
        • Baztán J.J.
        • Cáceres L.A.
        • Llanque J.L.
        • Gavidia J.J.
        • Ruipérez I.
        Predictors of functional recovery in older hospitalized adults.
        J Am Geriatr Soc. 2012 Jan; 60: 187-189
        • Boyd C.M.
        • Landefeld C.S.
        • Counsell S.R.
        • Palmer R.M.
        • Fortinsky R.H.
        • Kresevic D.
        • et al.
        Recovery of activities of daily living in older adults after hospitalization for acute medical illness.
        J Am Geriatr Soc. 2008; 56: 2171-2179
        • Formiga F.
        • Ferrer A.
        • Chivite D.
        • Pujol R.
        Survival after 7 years of follow-up at ninety. The NonaSantfeliu study.
        Eur J Intern Med. 2011; 22: e164-e165
        • Formiga F.
        • Ferrer A.
        • Lombarte I.
        • Fernández C.
        The NonaSantfeliu study. Baseline assessment and ten years of follow-up.
        Rev Esp Geriatr Gerontol. 2015; 50: 143-149
        • Barchel D.
        • Almoznino-Sarafian D.
        • Shteinshnaider M.
        • Tzur I.
        • Cohen N.
        • Golerik O.
        Clinical characteristics and prognostic significance of serum albumin changes in an internal medicine ward.
        Eur J Intern Med. 2013; 24: 772-778
        • Zafrir B.
        • Laor A.
        • Bitterman H.
        Nonagenarians in internal medicine: characteristics, outcomes and predictor for in-hospital and post-discharge mortality.
        Isr Med Assoc J. 2010; 12: 10-15
        • Inouye S.
        • Peduzzi N.
        • Robinson J.
        Importance of functional measures in predicting mortality among older hospitalized patients.
        JAMA. 1998; 279: 1187-1193
        • Campbell S.E.
        • Seymour D.G.
        • Primrose W.R.
        • Lynch J.E.
        • Dunstan E.
        • Espallargues M.
        • et al.
        A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project.
        Age Ageing. 2005; 34: 467-475
        • Helvik A.S.
        • Sebaek G.
        • Engedal K.
        Functional decline in older adults one year after hospitalization.
        Arch Gerontol Geriatr. 2013 Nov-Dec; 57: 305-310