BMC Geriatrics | |
Three-year mortality in previously hospitalized older patients from rural areas - the importance of co-morbidity and self-reported poor health | |
Geir Selbæk1  Knut Engedal2  Anne-Sofie Helvik3  | |
[1] Akershus University Hospital, Lørenskog, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;St Olav’s University Hospital, Trondheim, Norway | |
关键词: Survival analysis; Self-rated health; Hospitalization; Gender; Elderly; | |
Others : 857874 DOI : 10.1186/1471-2318-13-17 |
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received in 2012-12-04, accepted in 2013-02-14, 发布年份 2013 | |
【 摘 要 】
Background
The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality.
Methods
The study included 484 (241 men) medical inpatients with age range 65–101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody’s scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge.
Results
In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning.
Conclusion
In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies.
【 授权许可】
2013 Helvik et al; licensee BioMed Central Ltd.
【 预 览 】
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【 参考文献 】
- [1]Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997, 38:21-37.
- [2]Vuorisalmi M, Lintonen T, Jylha M: Global self-rated health data from a longitudinal study predicted mortality better than comparative self-rated health in old age. J Clin Epidemiol 2005, 58:680-687.
- [3]Schou MB, Krokstad S, Westin S: [How is self-rated health associated with mortality?]. Tidsskr Nor Laegeforen 2006, 126:2644-2647.
- [4]Thong MS, Kaptein AA, Benyamini Y: Association between a self-rated health question and mortality in young and old dialysis patients: a cohort study. Am J Kidney Dis 2008, 52:111-117.
- [5]Lee Y: The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. J Epidemiol Community Health 2000, 54:123-129.
- [6]Walker JD, Maxwell CJ, Hogan DB: Does self-rated health predict survival in older persons with cognitive impairment? J Am Geriatr Soc 2004, 52:1895-1900.
- [7]Scott WK, Macera CA, Cornman CB: Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol 1997, 50:291-296.
- [8]Ganguli M, Dodge HH, Mulsant BH: Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. Arch Gen Psychiatry 2002, 59:1046-1052.
- [9]Han B, Phillips C, Ferrucci L: Change in self-rated health and mortality among community-dwelling disabled older women. Gerontologist 2005, 45:216-221.
- [10]Lee SJ, Moody-Ayers SY, Landefeld CS: The relationship between self-rated health and mortality in older black and white Americans. J Am Geriatr Soc 2007, 55:1624-1629.
- [11]Onawola RS, LaVeist TA: Subjective health status as a determinant of mortality among African-American elders. J Natl Med Assoc 1998, 90:754-758.
- [12]Elliott AM, Hannaford PC, Smith BH: Symptom experience and subsequent mortality: results from the West of Scotland Twenty-07 study. BMC Health Serv Res 2006, 6:158. BioMed Central Full Text
- [13]Jylha M, Volpato S, Guralnik JM: Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol 2006, 59:465-471.
- [14]Mete C: Predictors of elderly mortality: health status, socioeconomic characteristics and social determinants of health. Health Econ 2005, 14:135-148.
- [15]Covinsky KE, Kahana E, Chin MH: Depressive symptoms and 3-year mortality in older hospitalized medical patients. Ann Intern Med 1999, 130:563-569.
- [16]Walter LC, Brand RJ, Counsell SR: Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001, 285:2987-2994.
- [17]Ponzetto M, Maero B, Maina P: Risk factors for early and late mortality in hospitalized older patients: the continuing importance of functional status. J Gerontol A Biol Sci Med Sci 2003, 58:1049-1054.
- [18]Drame M, Jovenin N, Novella JL: Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging 2008, 12:599-604.
- [19]Drame M, Novella JL, Lang PO: Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study. Eur J Epidemiol 2008, 23:783-791.
- [20]Pilotto A, Ferrucci L, Franceschi M: Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008, 11:151-161.
- [21]Levine SK, Sachs GA, Jin L: A prognostic model for 1-year mortality in older adults after hospital discharge. Am J Med 2007, 120:455-460.
- [22]Gudmundsson G, Gislason T, Lindberg E: Mortality in COPD patients discharged from hospital: the role of treatment and co-morbidity. Respir Res 2006, 7:109. BioMed Central Full Text
- [23]Goldberg RJ, Ciampa J, Lessard D: Long-term survival after heart failure: a contemporary population-based perspective. Arch Intern Med 2007, 167:490-496.
- [24]Covinsky KE, Martin GE, Beyth RJ: The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. J Am Geriatr Soc 1999, 47:532-538.
- [25]Covinsky KE, Justice AC, Rosenthal GE: Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 1997, 12:203-208.
- [26]Jonsson PV, Noro A, Finne-Soveri H: Admission profile is predictive of outcome in acute hospital care. Aging Clin Exp Res 2008, 20:533-539.
- [27]Hughes CP, Berg L, Danziger WL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982, 140:566-572.
- [28]Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993, 43:2412-2414.
- [29]Helvik A-S, Scanke RH, Selbæk G: Screening for depression in elderly medical inpatients from rural areas of Norway: prevalence and associated factors. Int J Geriatr Psychiatry 2010, 25:150-159.
- [30]Charlson ME, Pompei P, Ales KL: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383.
- [31]Quan H, Sundararajan V, Halfon P: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005, 43:1130-1139.
- [32]Schneeweiss S, Wang PS, Avorn J: Improved comorbidity adjustment for predicting mortality in Medicare populations. Health Serv Res 2003, 38:1103-1120.
- [33]Folstein MF, Folstein SE, McHugh PR: ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12:189-198.
- [34]Engedal K, Haugen P, Gilje K: Efficacy of short mental tests in the detection of mental impairment in old age. Compr Gerontol A 1988, 2:87-93.
- [35]Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9:179-186.
- [36]Selbaek G, Kirkevold O, Engedal K: The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry 2007, 22:843-849.
- [37]Barca M, Engedal K, Laks J: A 12 months follow-up study of depression among nursing home patients in Norway. J Affect Disord 2010, 120:141-148.
- [38]HUNT: The health Study in Nord-Trøndelag (HUNT). 2009. http://www.ntnu.no/dmf/hunt/skjema webcite[cited 2009 Janurary 20]
- [39]Achterberg W, Pot AM, Van Campen C: Resident Assessment Instrument (RAI): a review of international research on the psychometric qualities and effects of implementation in nursing homes. Tijdschr Gerontol Geriatr 1999, 30:264-270.
- [40]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67:361-370.
- [41]Snaith RP, Zigmond AS: The hospital anxiety and depression scale manual. Windsor: NFER-Nelson; 1994.
- [42]Olsson I, Mykletun A, Dahl AA: The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 2005, 5:46. BioMed Central Full Text
- [43]Helvik AS, Engedal K, Skancke RH: A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly. Nord J Psychiatry 2011. [Epublish ahead of print]
- [44]Holmen J, Midthjell K, Bjartveit K: The Nord-Trøndelag Health Survey 1984–86. Purpose, background and methods. Participation, non-participation and frequency distributions. : Helsetjenesteforskning. Senter for samfunnsmedisinsk forskning; 1990:257.
- [45]Holmen J, Midthjell K, Krüger Ø: The Nord-Trøndelag Health Study 1995–97 (HUNT 2): Objectives, contents, methods and participation. Norsk Epidemiologi 2003, 13:19-32.
- [46]Saevareid HI, Thygesen E, Nygaard HA: Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people? Aging Ment Health 2007, 11:658-667.
- [47]Benyamini Y, Idler EL, Leventhal H: Positive affect and function as influences on self-assessments of health: expanding our view beyond illness and disability. J. Gerontol. Series B, Psychological Sciens and Social Sciens 2000, 55:107-116.
- [48]Helvik A-S, Engedal K, Bjørkløf GH: Factors associated with perceived health in elderly medical inpatients: A particular focus on personal coping resourses. Ageing & Mental Health 2012, 16:795-803.
- [49]Helvik A-S, Jacobsen GW, Hallberg LR-M: Effects of Impaired Hearing on Perceived Health and Life Situation. SJDR 2006, 8:263-277.