A Simple Method of Recognizing Geriatric Patients at Risk for Death and Disability

OBJECTIVE: To identify prognostic indicators for geriatric patients discharged from an acute care hospital. DESIGN: Prospective observational study. SETTING: Base line assessment at discharge from an acute care hospital; reassessment after 1 year at home. PATIENTS: One hundred-seventy-eight consecutive patients over 70 years of age (mean age +/- SD = 75.6 +/- 13.1 years, range 70-95 years, 52% males); 56% were dependent in one or more Activities of Daily Living, 21% had abnormal Mini Mental State Scores. MAIN OUTCOME MEASURES: mortality, increasing physical dependence, health care utilization. RESULTS: Mortality was directly related to a low ADL score at hospital discharges (Odds Ratio = 3.31, Confidence Limits = 1.91-5.75), neoplastic disease (OR = 3.59, CL = 2.01-6.43), cardiovascular disease (OR = 2.47, CL = 1.40-4.36), and drug use, expressed as the total number of individual preparations prescribed at discharge (OR = 1.72, CL = 1.05-2.83). Low ADL score, cardiovascular and neoplastic disease were also predictive of increasing physical dependency. The use of health care services, quantified by an appropriately designed score, did not correlate with any of the baseline variables, with the implication that the use of the health care services was not proportional to the need for care. CONCLUSIONS: Elderly subjects at major risk of death and disability can be easily identified at discharge by a simple assessment of their medical and functional state.