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Dülger D, Albuz Ö. Risk indices that predict in-hospital mortality of elderly patients. Turk J Med Sci 2020; 50:969-977. [PMID: 32490649 PMCID: PMC7379462 DOI: 10.3906/sag-2005-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background/aim Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status. Material and methods We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayıs State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population. Results Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53–2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90–3.26), P < 0.001). Conclusion Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.
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Affiliation(s)
- Dilek Dülger
- Department of Microbiology, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Özgür Albuz
- Deparment of General Surgery, Keçiören Training and Research Hospital,Ankara,Turkey
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Fraade-Blanar LA, Hansen RN, Chan KCG, Sears JM, Thompson HJ, Crane PK, Ebel BE. Diagnosed dementia and the risk of motor vehicle crash among older drivers. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:47-53. [PMID: 29407668 PMCID: PMC5869102 DOI: 10.1016/j.aap.2017.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/13/2017] [Accepted: 12/28/2017] [Indexed: 05/28/2023]
Abstract
Older adults are an active and growing segment of drivers in the United States. We compared the risk of motor vehicle crash among older licensed drivers diagnosed with dementia to crash risk among older licensed drivers without diagnosis of dementia. This retrospective cohort study used data from Group Health (GH), a Washington State health maintenance organization. Research participants were members of GH, aged 65-79 during the study who lived in Washington State from 1999-2009. Participant health records were linked with police-reported crash and licensure records. We estimated the risk of crash for older drivers diagnosed with dementia compared to older drivers without diagnosis of dementia using a Cox proportional hazards model with robust standard errors, accounting for recurrent events (crashes). Multivariable models were adjusted for age, sex, history of alcohol abuse or depression, comorbidities, and medications. There were 29,730 eligible individuals with an active driving license. Approximately 6% were diagnosed with dementia before or during the study. The police-reported crash rate was 14.7 per 1000 driver-years. The adjusted hazard ratio of crash among older drivers with diagnosed dementia was 0.56 (95% CI 0.33, 0.95) compared to those without diagnosed dementia. On-road and simulator-based research showed older adults with dementia demonstrated impaired driving skill and capabilities. The observed lower crash risk in our study may result from protective steps to limit driving among older adults diagnosed with dementia. Future research should examine driving risk reduction strategies at the time of dementia diagnosis and their impact on reducing crash risk.
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Affiliation(s)
- Laura A Fraade-Blanar
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Harborview Injury Prevention Research Center, 401 Broadway, Seattle, WA, 98122, USA.
| | - Ryan N Hansen
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Department of Pharmacy, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Group Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA; Harborview Injury Prevention Research Center, 401 Broadway, Seattle, WA, 98122, USA
| | - Kwun Chuen G Chan
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Departments of Biostatistics, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA
| | - Jeanne M Sears
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Harborview Injury Prevention Research Center, 401 Broadway, Seattle, WA, 98122, USA; Institute for Work & Health, Institute for Work & Health, Ontario, Canada
| | - Hilaire J Thompson
- Harborview Injury Prevention Research Center, 401 Broadway, Seattle, WA, 98122, USA; Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA
| | - Paul K Crane
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Department of Medicine, University of Washington, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA
| | - Beth E Ebel
- Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Harborview Injury Prevention Research Center, 401 Broadway, Seattle, WA, 98122, USA; Department of Pediatrics, University of Washington and Seattle Children's Hospital; 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA; Department of Epidemiology, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195-5852, USA
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Betz ME, Jones J, Carr DB. System facilitators and barriers to discussing older driver safety in primary care settings. Inj Prev 2015; 21:231-7. [PMID: 25617342 DOI: 10.1136/injuryprev-2014-041450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Primary care physicians play a leading role in counselling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. OBJECTIVE To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a programme supporting routine conversations. METHODS This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. RESULTS From 15 interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterised their experiences in terms of current and ideal states. CONCLUSIONS Physicians have been tasked with assessing older driver safety and guiding older patients through the process of 'driving retirement.' Attention to system-level factors such as provider roles, resources, and training can support them in this process.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David B Carr
- Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. J Aging Res 2014; 2014:584315. [PMID: 25147737 PMCID: PMC4131474 DOI: 10.1155/2014/584315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 12/17/2022] Open
Abstract
Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%). Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6%) of the hospitalized patients were discharged, 85 (8.4%) died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.
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