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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Article info
Publication history
Published online: February 25, 2019
Accepted:
February 20,
2019
Received in revised form:
January 31,
2019
Received:
December 18,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
