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Profiling the hospital-dependent patient in a large academic hospital: Observational study

  • Andrea Ticinesi
    Correspondence
    Corresponding author at: Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma and Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy.
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy

    Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Antonio Nouvenne
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Beatrice Prati
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Fulvio Lauretani
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Ilaria Morelli
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Claudio Tana
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Massimo Fabi
    Affiliations
    General Management, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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  • Tiziana Meschi
    Affiliations
    Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy

    Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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Published:February 25, 2019DOI:https://doi.org/10.1016/j.ejim.2019.02.013

      Highlights

      • Hospital-dependence in older patients is associated with severe multimorbidity.
      • Hospital-dependence may arise also in subjects with a good functional status.
      • Frailty and cancer, but not multimorbidity, predict adverse outcomes in these patients.
      • The severity of multimorbidity is associated with length of stay and early readmissions.
      • Hospital-dependence implies a rapid decline of functional performance.

      Abstract

      Background

      In older patients with acute illness, a condition of “hospital-dependence” may arise: patients get adapted to the hospital care and, once discharged, may experience health status decline, requiring repeated readmissions despite appropriate treatments.

      Aims

      The objective of this case-series study was to describe the characteristics of 118 patients (72 F) aged ≥75 (mean 83.7 ± 4.9) who were urgently admitted to our institution at least 4 times in 2015.

      Methods

      For each patient and admission, data on multimorbidity (Cumulative Illness Rating Scale Comorbidity Score and Severity Index), frailty (Rockwood Clinical Frailty Scale), functional dependence, functional status, polypharmacy, length of stay and interval between admissions were extrapolated from clinical records. Mortality during the years 2015 and 2016 was assessed on the institutional database.

      Results

      At the first admission, patients had a high burden of polypharmacy (median number of drugs 8.5, IQR 6–11) and multimorbidity (Comorbidity Score 15.8 ± 4.1, Severity Index 2.9 ± 1.1). However, most (55.5%) were fit or pre-frail according to Clinical Frailty Scale (score 1–4). At multivariate models, Severity Index was significantly correlated with the length of stay (β ± SE 2.23 ± 0.89, p = .01) and readmission interval (β ± SE -22.49 ± 9.27, p = .02). Significantly increasing trends of multimorbidity and disability occurred across admissions. By the end of 2016, 66% of patients had died. Frailty (RR 2.005, 95%CI 1.054–3.814, p = .007) and cancer were the only predictors of mortality.

      Conclusions

      Hospital-dependent patients had severe multimorbidity, but exhibited an unexpectedly low prevalence of frailty/disability at baseline, though increasing across admissions. Trends of frailty and multimorbidity are paramount for profiling the hospital-dependence risk.

      Keywords

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