Ar. Williams et al., Mortality one-year postdischarge from a veterans affairs geriatric evaluation and management unit: Assessing mortality risks, J AM GER SO, 47(7), 1999, pp. 860-863
Citations number
27
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
OBJECTIVE: To assess at Geriatric Evaluation and Management Unit (GEM) admi
ssion factors that affect mortality 12-months postdischarge and to develop
a preliminary risk scoring protocol to guide targeting of GEM care.
SETTING: A 24 bed-GEM at a Veterans Affairs (VA) Medical Center.
DESIGN: Relative risks(RR) were assessed using prospective data; a risk pro
tocol from 1988-1989 data was tested on 1990-1991 patients.
SUBJECTS: A total of 283 male patients, aged 60 to 102, discharged over 4 y
ears.
RESULTS: Age at GEM admission did not correlate with death (r = .14; P = .1
45), but did correlate with risk scores (r = .33, P < .001). The risk proto
col had a sensitivity of .67 and specificity of 1.00. High and low risk pat
ients had mortalities of 51% versus 20%, a Wilcoxon (Gehan) statistic of 15
.22, df = 1, and P < .001. Differences in mortality ceased about 100 days p
ostdischarge. Three univariate RR exceeded 1.00 at a 99% Confidence Interva
l (CI): IADL score (RR: 1.12; CI, 1.03-1.21); nursing acuity score (RR: 1.7
8; CI: 1.02-3.11); and a primary diagnosis of pneumonia/sepsis (RR: 3.95; C
I, 1.60-9.78). Four RRs exceeded 1.00 at a 90% CI: dementia (RR: 1.78; CI,
1.02-3.09);transfer into the GEM from a medical service (RR: 1.47; CI, 1.02
-2.12); deconditioning/functional decline (RR: 1.67; CI, 1.12-2.48); and us
e of a Foley catheter (RR: 2.22; CI, 1.11-4.45), Thirteen other potential r
isk factors were found in a multivariate analysis.
CONCLUSIONS: The point estimates of risk factors may help clinicians target
GEM care, but the development of a useable risk protocol requires addition
al work. Causal models may be needed to assess patient conditions related t
o successful treatment in GEMs.