S. Satish et al., GERIATRIC TARGETING CRITERIA AS PREDICTORS OF SURVIVAL AND HEALTH-CARE UTILIZATION, Journal of the American Geriatrics Society, 44(8), 1996, pp. 914-921
OBJECTIVE: To assess the utility of geriatric targeting criteria in pr
edicting survival and health care utilization in a cohort of hospitali
zed older veterans. DESIGN: A prospective cohort study assessing geria
tric targeting criteria, e.g., polypharmacy, falls, or confusion, with
respect to adverse outcomes at 12 months. SETTING A Tertiary Care VA
Medical Center. PATIENTS: 507 acutely hospitalized male veterans aged
65 years or more. MAIN OUTCOME MEASURES: Survival status, nursing home
placement, and total hospital days during 12 months following hospita
l admission. RESULTS: Patients who had a higher number of targeting cr
iteria at admission showed a significantly increasing trend toward dea
th (P less than or equal to .001), nursing home placement (P less than
or equal to .01), and longer hospital stays (P less than or equal to
.01) at 12 months. In univariate analyses, weight loss (relative hazar
d 3.8, 95% CI 2.4, 5.9), appetite loss (relative hazard 3.3, 95% CI 1.
9, 5.8), depression (relative hazard 2.5, 95% CI 1.4, 4.5), falls (rel
ative hazard 2.2, 95% CI 1.2, 4.1), confusion (relative hazard 2.2, 95
% CI 1.2, 4.0), and socioeconomic problems (relative hazard 1.6, 95% C
I 1.0, 2.5) predicted death. Polypharmacy (OR 3.4, 95% CI 1.3, 8.8), c
onfusion (OR 4.4, 95% CI 1.5, 13.0), and prolonged bedrest (OR 7.6, 95
% CI 1.5, 39.3) predicted nursing home placement. Confusion (Beta 12.0
, 95% CI 2.9, 21.3), falls (Beta 14.2, 95% CI 4.2, 24.3), and prolonge
d bedrest (Beta 22.4, 95% CI 3.9, 41.0) predicted total hospital days.
In multivariate analyses, weight loss, depression, and socioeconomic
problems predicted death; confusion and polypharmacy predicted nursing
home placements; and falls predicted total, hospital days. CONCLUSION
: This prospective cohort study of hospitalized older veterans demonst
rated geriatric targeting criteria as predictors of adverse hospital o
utcomes. Our findings suggest screening acutely hospitalized patients
using chart abstracted geriatric targeting criteria is useful in ident
ifying patients at risk for adverse outcomes of hospitalization.