A systematic literature review of factors affecting outcome in older medical patients admitted to hospital

David Gwyn Seymour, Susan Elizabeth Campbell, W. R. Primrose, ACMEplus Project Team

Research output: Contribution to journalArticle

241 Citations (Scopus)

Abstract

Introduction: the ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify, factors which had a significant influence on outcome in such patients.

Methods: the systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented.

Results: the main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were:

i. For length of stay: functional status score, illness severity, cognitive Score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.

ii. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.

iii. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age.

iv. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy diagnosis or presenting illness and age.

Conclusions: factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.

Original languageEnglish
Pages (from-to)110-115
Number of pages5
JournalAge and Ageing
Volume33
DOIs
Publication statusPublished - 2004

Keywords

  • systematic review
  • outcome assessment (health care)
  • aged (80 years and over)
  • prospective studies
  • length of stay
  • elderly
  • prognosis
  • hospital admission
  • CASE-MIX SYSTEM
  • GERIATRIC-PATIENTS
  • FUNCTIONAL STATUS
  • ELDERLY PATIENTS
  • ADMISSION
  • LENGTH
  • STAY
  • MORTALITY
  • CARE
  • ACME

Cite this

A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. / Seymour, David Gwyn; Campbell, Susan Elizabeth; Primrose, W. R.; ACMEplus Project Team.

In: Age and Ageing, Vol. 33, 2004, p. 110-115.

Research output: Contribution to journalArticle

Seymour, David Gwyn ; Campbell, Susan Elizabeth ; Primrose, W. R. ; ACMEplus Project Team. / A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. In: Age and Ageing. 2004 ; Vol. 33. pp. 110-115.
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abstract = "Introduction: the ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify, factors which had a significant influence on outcome in such patients.Methods: the systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented.Results: the main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were:i. For length of stay: functional status score, illness severity, cognitive Score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.ii. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.iii. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age.iv. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy diagnosis or presenting illness and age.Conclusions: factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.",
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AU - Seymour, David Gwyn

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AU - Primrose, W. R.

AU - ACMEplus Project Team

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N2 - Introduction: the ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify, factors which had a significant influence on outcome in such patients.Methods: the systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented.Results: the main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were:i. For length of stay: functional status score, illness severity, cognitive Score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.ii. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.iii. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age.iv. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy diagnosis or presenting illness and age.Conclusions: factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.

AB - Introduction: the ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify, factors which had a significant influence on outcome in such patients.Methods: the systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented.Results: the main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were:i. For length of stay: functional status score, illness severity, cognitive Score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.ii. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender.iii. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age.iv. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy diagnosis or presenting illness and age.Conclusions: factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.

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KW - outcome assessment (health care)

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KW - prospective studies

KW - length of stay

KW - elderly

KW - prognosis

KW - hospital admission

KW - CASE-MIX SYSTEM

KW - GERIATRIC-PATIENTS

KW - FUNCTIONAL STATUS

KW - ELDERLY PATIENTS

KW - ADMISSION

KW - LENGTH

KW - STAY

KW - MORTALITY

KW - CARE

KW - ACME

U2 - 10.1093/ageing/afh036

DO - 10.1093/ageing/afh036

M3 - Article

VL - 33

SP - 110

EP - 115

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

ER -