Hospitalize yaşlı hastalarda hastane içi morbidite ve mortaliteyi öngörmede kapsamlı geriatrik değerlendirmenin rolü

Abstract

Comprehensive geriatric assessment is an important part of geriatric patient assessment. It is cornerstone of predicting the morbidity and mortality of patients. The aim of this study is to evaluate the factors that play a role in morbidity and mortality in patients aged 65 and over, hospitalized in Hacettepe University Hospital internal medicine wards. Patients’s length of stay, infection status, development of pressure ulcers, delirium and transfer to intensive care unit were examined. Mortality could not be analyzed because of the insufficient number of participants. Demographic properties, anthropometric measurements, habits, and current comorbidities of the patients were noted and geriatric syndromes were assessed. The patients were evaluated nutritionally and cognitively with mini nutritional assessment, scales for basic and instrumental daily living activities, geriatric depression scale, clinical frailty scale and mini mental state examination test. A total of 113 patients were included in the study. Fifty eight (48,7%) patients were female and fifty five (51,3%) patients were male. A total of 113 patients’ mean age was 74.0±7.1 and ranges from 65 to 94. The patients were hospitalized from emergency room or from outpatient clinic. The patients were evaluated within the first three days of their hospitalization. Patients with low nutritional status (p=0.043; r=0.191), low body mass index (p=0.063; r=0.176), low length of midarm (p=0.026; r=0.209) and calf (p=0.016; r=0.226) circumference were more associated with shorter length of stay. Weight loss in the past year were associated with longer length of stay (p=0.009; r=0.248). It was shown that influenza vaccination was associatied with shorter duration of hospitalization (p=0.041). Functional and cognitive capacity or current comorbidities, smoking and alcohol use, laboratory values were no associated with length of stay. Extended stay was independently associated with malnutrition and polypharmacy. Using five or more drugs reduces probability of staying in hospital more than ten days approximately three times (%95 Cl=0.132-0.823). Patients undergoing malnutrition or risk of malnutrition is associated with stay in hospital more ten days approximetly 2.9 times (%95 Cl:1.296-6.869). Mortality, falls, pressure ulcers, delirium and transfer to intensive care unit could not be analyzed because of the insufficient number of participants. As a result, it is necessary to evaluate nutritional status and polypharmacy of geriatric inpatients. Although polypharmacy has a good prognosis on length of stay in this study, more studies are needed to assess the effect of polypharmacy on length of stay. It is very important to evaluate the nutritional status and number of drugs in each hospitalized geriatric patient and it is related to prognosis.