Anemia in hospitalized elderly patients: the REPOSI study
Several studies have demonstrated a high prevalence of anemia in elderly community-dwelling individuals, but few previous studies have focused on hospitalized elderly patients. Anemia, even mild, is associated with negative outcomes, including prolonged hospital stay and in-hospital mortality. The aims of this study were to evaluate: (i) the prevalence of anemia in elderly patients acutely admitted to internal medicine and geriatric wards; (ii) the association between anemia and comorbidity, polypharmacy at admission and some diseases (chronic obstructive pulmonary disease, cardio-cerebral vascular diseases, neoplasms, chronic renal failure, gastrointestinal disorders, diabetes) and their correlation with severity of anemia; (iii) the role of anemia in predicting the length of hospital stay and in-hospital mortality.
Prevalence and characteristics of the use of lipid-lowering agents in a population of elderly hospitalized patients
A total of 2171 subjects older than 65 were enrolled (1057 males, 1114 females, mean age 78.6 yr). The number of patients treated with lipid lowering drugs was 508 (23.4%) with no gender difference. Among statin-treated patients, atorvastatin (39.3%) and simvastatin (34.0%) were the most used drugs. The prevalence of drug use was higher in patients under polypharmacological treatment (≥ 5 drugs) and with a higher CIRS score. At logistic regression analysis the presence of coronary heart disease, peripheral vascular disease and hypertension were significantly correlated with lipid lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment.
Antipsychotic prescription in older persons and mortality during hospitalization and 3 months after discharge
Among 2703 patients included in the study, 135 (5%) received new prescriptions of antipsychotic drugs. The most frequently prescribed antipsychotics during hospitalization and eventually maintained at discharge were: haloperidol (38 and 36% of cases, respectively), promazine (28 and 20%) and quietapine (12 and 11%). Antipsychotics-group patients were older and had a higher CIRS comorbidity index both at admission and at discharge compared to those not prescribed with antipsychotics. Seventy-one percent of those prescribed with antipsychotics had a SBT score≥10 (indicative of dementia); 12% a SBT score from 5 to 9 (indicative of questionable dementia); and 17% a SBT score <5 (indicative of normal cognition). In- hospital mortality was slightly higher in patients prescribed with antipsychotic drugs (14.3% vs. 9.4%; p=0.109), but in multivariate analysis only a higher CIRS and SBT scores were significantly related to mortality during hospitalization. At follow-up, male sex, older age, and higher SBT scores were the only factors associated with mortality.
Defining aging phenotypes and related outcomes: clues to recognize frailty in hospitalized older patients
2841 patients were included in the statistical analyses. Four clusters were identified: the healthiest (I); the patients with multimorbidity (II); the functionally independent females with osteoporosis and arthritis (III); the functionally dependent oldest old patients with cognitive impairment (IV). There was a significantly higher in-hospital mortality in Cluster II (OR 2.27, 95% CI 1.15-4.46) and Cluster IV (OR 5.15, 95% CI 2.58- 10.26) and a higher 3-month mortality in Cluster II (OR 1.66, 95% CI 1.13-2.44) and in Cluster IV (OR 1.86, 95% CI 1.15-3.00) than in Cluster I. Using alternative analytical techniques, among hospitalized older patients, we could distinguish different frailty phenotypes, differently associated with adverse events. The identification of different patients profiles can help defining the best care strategy according to specific patients needs.
Therapeutic duplicates in a cohort of hospitalized elderly patients: results from the REPOSI study
Explicit criteria for potentially inappropriate prescription in the elderly recommend to avoid any duplicate drug class prescription and optimize monotherapy within a single drug class before considering a new agent. Therapeutic duplicates were defined as prescribing at least two drugs of the same therapeutic class simultaneously to the same patients. The study sample comprised 5,821 patients admitted and 4,983 discharged. In all, 143 therapeutic duplicates were found at admission and 170 at discharge. The prevalence of patients exposed to at least one therapeutic duplicate rose significantly from hospital admission (2.5%) to discharge (3.4%; p=0.0032). Psychotropic drugs and drugs for peptic ulcer or gastro- esophageal reflux disease were the most frequent drugs involved. Among the patients discharged with at least one therapeutic duplicate 86.8% still had them at the three-month follow-up.
Risk factors for 3-months mortality after discharge in a cohort of non-oncological hospitalized elderly patients.
Short-term prognosis, e.g. mortality at 3 months, has many important implications in planning the overall management of patients, but to assess this short term-prognosis is difficult, particularly in non-oncological patients. Performance status is a potent predictor of mortality. The sample included all patients with 3- months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during all the hospitalization. The following parameters were also recorded: estimated GFR ≤ 29 ml/min/1.73 m2; severe dementia; albuminemia <2.5 g/dL; hospital admissions in the six months before the index admission.
Among 3,915 patients eligible for the analysis data about 3-months follow-up were available for 2,058 patients and were included in the study. 181 (8.8%) patients died between discharge and 3-months follow- up. Bedridden patients were 112 and the absolute risk difference of mortality was 0.13 (CI 95% 0.08-0.19, p< 0.0001). Patients with at least one risk factor considered in the study were 882 (42.6%). Mortality was significantly higher among these patients (12.9% vs 4.1%. p<0.0001). Logistic regression analysis adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition, severely reduced kidney function, hospital admission in the previous 6 months and severe dementia with total or severe level of physical dependence were associated with an higher risk of 3-month mortality. Results were confirmed in the analysis on the sample of patients with measure of serum albumin.