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Eur J Intern Med. 2016 Jul;32:38-42. doi: 10.1016/j.ejim.2016.04.003. Epub 2016 May 4.

Predictors of clinical events occurring during hospital stay among elderly patients admitted to medical wards in Italy.

Author information

1
Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: paolo.rossi@policlinico.mi.it.
2
Geriatric Medicine Outpatient Service, Presidio Territoriale Poliambulatori, ASST Nord Milano, viale Andrea Doria 52, 20124 Milan, Italy. Electronic address: claudio.bilotta@gmail.com.
3
Department of Preventive Medicine, Unit of Epidemiology, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: dario.consonni@unimi.it.
4
Laboratory for Quality Assessment of Geriatric Therapies and Services, Mario Negri Institute for Pharmacological Research, Milan, Italy. Electronic address: alessandro.nobili@marionegri.it.
5
School of Specialization in Geriatrics and Gerontology, University of Milan, Milan, Italy. Electronic address: sarah.damanti@hotmail.it.
6
Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy. Electronic address: maura.marcucci@unimi.it.
7
A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. Electronic address: piermannuccio.mannucci@policlinico.mi.it.
8
Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy. Electronic address: daniela.mari@unimi.it.

Abstract

BACKGROUND:

Clinical events occurring during hospital stay are independent predictors of prolonged hospitalization, in-hospital mortality and readmission among elderly patients admitted to medical wards.

PURPOSE:

To identify predictors of intercurrent clinical events (ICE) during hospital stay among the main demographic, functional and clinical characteristics assessed at hospital admission in a multicenter sample of elderly inpatients in Italy.

METHODS:

This observational prospective cohort study was conducted in 66 internal and geriatric medicine hospital wards in 2010. It enrolled 1267 inpatients aged 65years or older living at home before hospitalization. Multivariable Poisson regression analyses were employed to identify the most common ICEs as well as their independent predictors.

RESULTS:

During the hospital stay 427 patients (33.7%) experienced at least one ICE. The most common ICEs were urinary tract infections, pneumonia, anemia, arrhythmias and fluid electrolyte disorders. After correction for age, sex, comorbidity, cognitive impairment and functional dependence, independent predictors of any ICE were: being a bladder catheter holder (RR [risk ratio] 1.86, 95% CI 1.52-2.27), being on treatment at home with a proton pump inhibitor (PPI) (RR 1.25, 95% CI 1.03-1.53), with immunosuppressant therapy (RR 2.10, 95% CI 1.24-3.56), and body temperature at admission (RR 1.19, 95% CI 1.06-1.33).

CONCLUSION:

Four clinical characteristics, easily assessable at admission, may be useful to identify elderly inpatients at a higher risk for developing ICEs during hospital stay. Furthermore three of these predictors are modifiable factors, thus interventions reducing the use of catheter, PPI and immunosuppressants may result in reduction of ICEs.

KEYWORDS:

Adverse events; Elderly; Hospitalization; Intercurrent clinical events; REPOSI

PMID:
27157402
DOI:
10.1016/j.ejim.2016.04.003
[Indexed for MEDLINE]

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