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Outcomes following unplanned admission to hospital in older people: ill-defined conditions as indicators of the frailty trajectory

Outcomes following unplanned admission to hospital in older people: ill-defined conditions as indicators of the frailty trajectory
Outcomes following unplanned admission to hospital in older people: ill-defined conditions as indicators of the frailty trajectory
Objectives: To describe outcomes after unplanned hospital admission in older people and to determine whether disease trajectories in those admitted with ill-defined conditions (symptoms and signs) are distinct from other diagnostic groups and consistent with known disease trajectories.

Design: Longitudinal follow-up after a retrospective cross-sectional study of emergency admissions to general internal and geriatric medicine units in one hospital.

Setting: Acute hospital in southern England.

Participants: All people aged 65 and older with unplanned admissions to general internal and geriatric medicine inpatient units during 2002 (N = 5,312).

Measurements: Age, sex, comorbidity, presence of cognitive and mood disorders, residence, and primary diagnostic group at discharge. Outcomes were death up to 36 months from admission, any readmission, and readmission for ill-defined conditions up to 36 months after discharge.

Results: There were significant differences in death rates between the diagnostic groups, with mortality being highest in individuals with a primary diagnosis of cancer and lowest in the ill-defined conditions group. Nearly 83% of the ill-defined conditions group survived the follow-up period. Adjusted Cox proportional hazard models indicated that, when age, sex, comorbidity, residence, and cognitive and mood disorders were accounted for, the ill-defined condition group had a lower risk of death but a higher risk of subsequent readmissions for ill-defined conditions than any other group. Overall readmission risk was highest for individuals admitted for a respiratory condition but was similar in all other diagnostic groups.

Conclusion: The lower mortality risk associated with ill-defined conditions is consistent with chronic rather than acute needs, but the pattern of mortality and readmission is more consistent with the frailty than the chronic organ system failure illness trajectory, suggesting that functional support needs may be more important in this group of individuals.
0002-8614
2104-2109
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Corner, Jessica
eddc9d69-aa12-4de5-8ab0-b20a6b5765fa
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Corner, Jessica
eddc9d69-aa12-4de5-8ab0-b20a6b5765fa

Walsh, Bronagh, Addington-Hall, Julia, Roberts, Helen C., Nicholls, Peter G. and Corner, Jessica (2012) Outcomes following unplanned admission to hospital in older people: ill-defined conditions as indicators of the frailty trajectory. Journal of the American Geriatrics Society, 60 (11), 2104-2109. (doi:10.1111/j.1532-5415.2012.04198.x). (PMID:23039237)

Record type: Article

Abstract

Objectives: To describe outcomes after unplanned hospital admission in older people and to determine whether disease trajectories in those admitted with ill-defined conditions (symptoms and signs) are distinct from other diagnostic groups and consistent with known disease trajectories.

Design: Longitudinal follow-up after a retrospective cross-sectional study of emergency admissions to general internal and geriatric medicine units in one hospital.

Setting: Acute hospital in southern England.

Participants: All people aged 65 and older with unplanned admissions to general internal and geriatric medicine inpatient units during 2002 (N = 5,312).

Measurements: Age, sex, comorbidity, presence of cognitive and mood disorders, residence, and primary diagnostic group at discharge. Outcomes were death up to 36 months from admission, any readmission, and readmission for ill-defined conditions up to 36 months after discharge.

Results: There were significant differences in death rates between the diagnostic groups, with mortality being highest in individuals with a primary diagnosis of cancer and lowest in the ill-defined conditions group. Nearly 83% of the ill-defined conditions group survived the follow-up period. Adjusted Cox proportional hazard models indicated that, when age, sex, comorbidity, residence, and cognitive and mood disorders were accounted for, the ill-defined condition group had a lower risk of death but a higher risk of subsequent readmissions for ill-defined conditions than any other group. Overall readmission risk was highest for individuals admitted for a respiratory condition but was similar in all other diagnostic groups.

Conclusion: The lower mortality risk associated with ill-defined conditions is consistent with chronic rather than acute needs, but the pattern of mortality and readmission is more consistent with the frailty than the chronic organ system failure illness trajectory, suggesting that functional support needs may be more important in this group of individuals.

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More information

e-pub ahead of print date: 5 October 2012
Published date: November 2012
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 338185
URI: http://eprints.soton.ac.uk/id/eprint/338185
ISSN: 0002-8614
PURE UUID: 28d43a9f-484e-4234-87ef-fb1677e0c476
ORCID for Bronagh Walsh: ORCID iD orcid.org/0000-0003-1008-0545
ORCID for Helen C. Roberts: ORCID iD orcid.org/0000-0002-5291-1880

Catalogue record

Date deposited: 10 May 2012 13:41
Last modified: 17 Dec 2019 01:55

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Contributors

Author: Bronagh Walsh ORCID iD
Author: Peter G. Nicholls
Author: Jessica Corner

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