Relationship between age and in-hospital mortality during 15,345,025 non-surgical hospitalizations

In-Hospital Mortality in Patients with and without Dementia across Age Groups, Clinical Departments, and Primary Admission Diagnoses

BACKGROUND

Studies have reported higher in-hospital mortality rates in patients living with dementia (PlwD) with limited evidence across age groups, clinical departments, and admission diagnoses. The aim of this study was to compare the in-hospital mortality rate of PlwD with patients without dementia across groups, clinical departments, and admission diagnoses.

METHODS

This case-control study included patients aged ≥ 60 years hospitalized in 1 of 14 German hospitals between January 2019 and July 2023. PlwD were matched to patients without dementia. The associations between dementia and in-hospital mortality across groups were assessed using univariable logistic regression analyses.

RESULTS

15,956 patients with and 15,956 without dementia were included (mean age: 83.9 years, 60.7% female). PlwD had a significantly higher in-hospital mortality rate (14.0% vs. 11.7%; OR 1.24, 95% CI: 1.16-1.32) than non-dementia controls. The highest excess mortality rate was observed in the youngest age group (60-70 years: 10.9% vs. 5.7%; OR: 2.05, 95% CI: 1.30-3.24), decreased with age, and became non-significant in the oldest age group (≥90 years: 16.2% vs. 17.3%; OR: 0.93, 95% CI: 0.80-1.08). Significant differences were found for digestive system disorders (OR: 1.59; 95% CI: 1.15-1.89), cardiovascular and cerebrovascular disorders (OR: 1.51; 95% CI: 1.30-1.75), endocrine, nutritional, and metabolic diseases (OR: 1.42; 95% CI: 1.06-1.90), and pneumonia (OR: 1.20; 95% CI: 1.04-1.37), as well as for all clinic departments except for geriatric departments.

CONCLUSION

The excess mortality rate was highest in younger age groups, where the general mortality and complication rate is relatively low in the general population. Appropriate approaches are needed, especially in non-geriatric wards.

Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022

Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods  This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results  In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions  This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.

Association between changes in potentially inappropriate medication use and adverse outcomes during hospitalization in older adults: A retrospective study

PURPOSE

To evaluate the association between the change in the number of PIMs in older adults during hospitalization and adverse outcomes.

METHODS

This retrospective cohort study was conducted in the internal medicine wards of a tertiary teaching hospital between May and December 2017. 3,460 patients (77.5±8.4 years, 60.4% male) were enrolled, and 206 patients died during hospitalization. PIMs were defined using the Beers Criteria as suggested by the American Geriatrics Society. Adverse outcomes studied were functional decline (a loss in 1 or more activities of daily living from admission to discharge), prolonged length of stay (LOS) (≥14 days), and mortality.

RESULTS

2258 patients (65.3%) had increasing PIMs during hospitalization. They tended to be younger (77.0±8.3 versus 78.5±8.5 years, p<0.001) and had lower numbers of PIMs at admission (0.4±0.8 versus 0.8±1.1, p<0.001). Increasing PIM use was strongly associated with greater functional decline (aOR 1.36, 95%CI 1.01-1.67, p=0.005), prolonged LOS (aOR 3.47, 95%CI 2.71-4.44, p<0.001) and higher mortality rate (aOR 2.68, 95%CI 1.75-4.12, p<0.001), even after adjusting for all covariates. We observed a strong association between adverse outcomes and increasing PIMs in older adults during hospitalization (p for trend <0.001).

CONCLUSIONS

Older adults with increasing PIMs during hospitalization were at greater risk for functional decline, prolonged LOS, and mortality, especially in those with three or more PIMs. Further studies are needed to better understand the complex interactions and to evaluate the effectiveness of intervention programs to lower PIM number and improve discharge outcomes for patients who had increasing PIM use during hospitalization.

Factors Associated With Mortality in Elderly Hospitalized Patients at Admission

Background

Several factors have been associated with mortality prediction among older inpatients. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients.

Methods

A total of 353 consecutively admitted elderly patients (47.9% women), with a median age of 83 years (interquartile range 75.00-88.00), were enrolled in the study and patient characteristics were recorded. Comorbidities were assessed using Charlson Comorbidity Index (CCI), activities of daily living by Barthel Index (BI), frailty was assessed using the Clinical Frailty Scale (CFS), cognition by Global Deterioration Scale (GDS) and symptom severity at admission by quick Sequential Organ Function Assessment (qSOFA) score. CFS, GDS and BI were estimated for the premorbid patients’ status. Parametric and non-parametric tests and binary logistic regression analysis were applied to identify the factors associated with mortality. A receiver operating characteristic (ROC) curve was used to analyse the prognostic value of CFS and qSOFA.

Results

In total, 55 patients (15.6%) died during hospitalization. In regression analysis, the factors associated with mortality were the qSOFA score at admission (p=0.001, odds ratio [OR]=1.895, 95% confidence interval [CI] 1.282-2.802) and the premorbid CFS score (p=0.001, OR=1.549, 95% CI 1.1204-1.994). The classifiers both have almost similar area under the curve (AUC) scores, with CFS performing slightly better. More specifically, both CFS (AUC 0.79, 95% CI 0.73-0.85, p=0.001) and qSOFA (AUC 0.75, 95% CI 0.67-0.83, p<0.001) showed almost the same accuracy for predicting inpatients’ mortality.

Conclusion

This study strengthens the perception of premorbid frailty and disease severity at admission as factors closely related to mortality in hospitalized elderly patients. Simple measures such as CFS and qSOFA score may help identify, in the emergency department, elderly patients at risk, in order to provide timely interventions.