Predictors of early mortality among hospitalized nursing home residents

Y A Alrawi, R A Parker, R C Harvey, S J Sultanzadeh, J Patel, R Mallinson, J F Potter, N J B Trepte, P K Myint

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Emergency admissions from nursing homes (NHs) are associated with high mortality. Understanding the predictors of early mortality in these patients may guide clinicians in choosing appropriate site and level of care.

Methods: We identified all consecutive admissions from NHs (all ages) to an Acute Medical Assessment Unit between January 2005 and December 2007. Analysis was performed at the level of the admission. The predictors of in-patient mortality at 7 days were examined using a generalized estimating equations analysis.

Results: A total of 314 patients [32% male, mean age: 84.2 years (SD: 8.3 years)] were admitted during the study period constituting 410 emergency episodes. Twenty-three percent of admissions resulted in hospital mortality with 73% of deaths occurring within 1 week (50% within the first 3 days). For 7-day mortality outcome, patients with a modified early warning score (MEWS) of 4–5 on admission had 12 times the odds of death [95% confidence interval (CI) 1.40–103.56], whereas those with a score of ≥6 had 21 times the odds of death (95% CI 2.71–170.57) compared with those with a score of ≤1. An estimated glomerular filtration rate (eGFR) of 30–60 and <30 ml/min/m2 was associated with nearly a 3-fold increase in the odds of death at 1 week (95% CI 1.10–7.97) and a 5-fold increase in the odds of death within 1 week (95% CI 1.75–14.96), respectively, compared with eGFR > 60 ml/min/m2. C-reactive protein (CRP) >100 mg/l on admission was also associated with a 2.5 times higher odds of death (95% CI 1.23–4.95). Taking eight or more different medication items per day was associated with only a third of the odds of death (95% CI 0.09–0.98) compared with patients taking only three or fewer per day.

Conclusion: In acutely ill NH residents, MEWS is an important predictor of early hospital mortality and can be used in both the community and the hospital settings to identify patients whose death maybe predictable or unavoidable, thus allowing a more holistic approach to management with discussion with patient and relatives for planning of immediate care. In addition, CRP and eGFR levels on admission have also been shown to predict early hospital mortality in these patients and can be used in conjunction with MEWS in the same way to allow decision making on the appropriate level of care at the point of hospital admission.
Original languageEnglish
Pages (from-to)51-57
Number of pages7
JournalQJM
Volume106
Issue number1
Early online date12 Oct 2012
DOIs
Publication statusPublished - Jan 2013

Fingerprint

Nursing Homes
Mortality
Hospital Mortality
Confidence Intervals
Glomerular Filtration Rate
C-Reactive Protein
Emergency Nursing
Point-of-Care Systems
Community Hospital
Decision Making
Emergencies

Keywords

  • aged
  • aged, 80 and over
  • biological markers
  • C-reactive protein
  • emergencies
  • England
  • female
  • geriatric assessment
  • health status indicators
  • homes for the aged
  • hospital mortality
  • hospitalization
  • humans
  • male
  • medical audit
  • nursing homes
  • prognosis
  • risk assessment

Cite this

Alrawi, Y. A., Parker, R. A., Harvey, R. C., Sultanzadeh, S. J., Patel, J., Mallinson, R., ... Myint, P. K. (2013). Predictors of early mortality among hospitalized nursing home residents. QJM, 106(1), 51-57. https://doi.org/10.1093/qjmed/hcs188

Predictors of early mortality among hospitalized nursing home residents. / Alrawi, Y A; Parker, R A; Harvey, R C; Sultanzadeh, S J; Patel, J; Mallinson, R; Potter, J F; Trepte, N J B; Myint, P K.

In: QJM, Vol. 106, No. 1, 01.2013, p. 51-57.

Research output: Contribution to journalArticle

Alrawi, YA, Parker, RA, Harvey, RC, Sultanzadeh, SJ, Patel, J, Mallinson, R, Potter, JF, Trepte, NJB & Myint, PK 2013, 'Predictors of early mortality among hospitalized nursing home residents', QJM, vol. 106, no. 1, pp. 51-57. https://doi.org/10.1093/qjmed/hcs188
Alrawi YA, Parker RA, Harvey RC, Sultanzadeh SJ, Patel J, Mallinson R et al. Predictors of early mortality among hospitalized nursing home residents. QJM. 2013 Jan;106(1):51-57. https://doi.org/10.1093/qjmed/hcs188
Alrawi, Y A ; Parker, R A ; Harvey, R C ; Sultanzadeh, S J ; Patel, J ; Mallinson, R ; Potter, J F ; Trepte, N J B ; Myint, P K. / Predictors of early mortality among hospitalized nursing home residents. In: QJM. 2013 ; Vol. 106, No. 1. pp. 51-57.
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abstract = "Background: Emergency admissions from nursing homes (NHs) are associated with high mortality. Understanding the predictors of early mortality in these patients may guide clinicians in choosing appropriate site and level of care.Methods: We identified all consecutive admissions from NHs (all ages) to an Acute Medical Assessment Unit between January 2005 and December 2007. Analysis was performed at the level of the admission. The predictors of in-patient mortality at 7 days were examined using a generalized estimating equations analysis.Results: A total of 314 patients [32{\%} male, mean age: 84.2 years (SD: 8.3 years)] were admitted during the study period constituting 410 emergency episodes. Twenty-three percent of admissions resulted in hospital mortality with 73{\%} of deaths occurring within 1 week (50{\%} within the first 3 days). For 7-day mortality outcome, patients with a modified early warning score (MEWS) of 4–5 on admission had 12 times the odds of death [95{\%} confidence interval (CI) 1.40–103.56], whereas those with a score of ≥6 had 21 times the odds of death (95{\%} CI 2.71–170.57) compared with those with a score of ≤1. An estimated glomerular filtration rate (eGFR) of 30–60 and <30 ml/min/m2 was associated with nearly a 3-fold increase in the odds of death at 1 week (95{\%} CI 1.10–7.97) and a 5-fold increase in the odds of death within 1 week (95{\%} CI 1.75–14.96), respectively, compared with eGFR > 60 ml/min/m2. C-reactive protein (CRP) >100 mg/l on admission was also associated with a 2.5 times higher odds of death (95{\%} CI 1.23–4.95). Taking eight or more different medication items per day was associated with only a third of the odds of death (95{\%} CI 0.09–0.98) compared with patients taking only three or fewer per day.Conclusion: In acutely ill NH residents, MEWS is an important predictor of early hospital mortality and can be used in both the community and the hospital settings to identify patients whose death maybe predictable or unavoidable, thus allowing a more holistic approach to management with discussion with patient and relatives for planning of immediate care. In addition, CRP and eGFR levels on admission have also been shown to predict early hospital mortality in these patients and can be used in conjunction with MEWS in the same way to allow decision making on the appropriate level of care at the point of hospital admission.",
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N2 - Background: Emergency admissions from nursing homes (NHs) are associated with high mortality. Understanding the predictors of early mortality in these patients may guide clinicians in choosing appropriate site and level of care.Methods: We identified all consecutive admissions from NHs (all ages) to an Acute Medical Assessment Unit between January 2005 and December 2007. Analysis was performed at the level of the admission. The predictors of in-patient mortality at 7 days were examined using a generalized estimating equations analysis.Results: A total of 314 patients [32% male, mean age: 84.2 years (SD: 8.3 years)] were admitted during the study period constituting 410 emergency episodes. Twenty-three percent of admissions resulted in hospital mortality with 73% of deaths occurring within 1 week (50% within the first 3 days). For 7-day mortality outcome, patients with a modified early warning score (MEWS) of 4–5 on admission had 12 times the odds of death [95% confidence interval (CI) 1.40–103.56], whereas those with a score of ≥6 had 21 times the odds of death (95% CI 2.71–170.57) compared with those with a score of ≤1. An estimated glomerular filtration rate (eGFR) of 30–60 and <30 ml/min/m2 was associated with nearly a 3-fold increase in the odds of death at 1 week (95% CI 1.10–7.97) and a 5-fold increase in the odds of death within 1 week (95% CI 1.75–14.96), respectively, compared with eGFR > 60 ml/min/m2. C-reactive protein (CRP) >100 mg/l on admission was also associated with a 2.5 times higher odds of death (95% CI 1.23–4.95). Taking eight or more different medication items per day was associated with only a third of the odds of death (95% CI 0.09–0.98) compared with patients taking only three or fewer per day.Conclusion: In acutely ill NH residents, MEWS is an important predictor of early hospital mortality and can be used in both the community and the hospital settings to identify patients whose death maybe predictable or unavoidable, thus allowing a more holistic approach to management with discussion with patient and relatives for planning of immediate care. In addition, CRP and eGFR levels on admission have also been shown to predict early hospital mortality in these patients and can be used in conjunction with MEWS in the same way to allow decision making on the appropriate level of care at the point of hospital admission.

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KW - emergencies

KW - England

KW - female

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KW - health status indicators

KW - homes for the aged

KW - hospital mortality

KW - hospitalization

KW - humans

KW - male

KW - medical audit

KW - nursing homes

KW - prognosis

KW - risk assessment

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