Objective
To determine the demographic and clinical predictors of in-hospital mortality among
hospitalized nursing home (NH) residents.
Design
Retrospective analysis of the public-use copies of the 2005–2006 National Hospital
Discharge Survey (NHDS) datasets.
Setting
Non-federal acute-care, short-stay hospitals in all 50 states and the District of
Columbia.
Participants
Participants were 1904 and 1752 NH residents, 45 years or older, hospitalized in 2005
and 2006, respectively.
Measurements
In-hospital mortality.
Methods
A multivariable logistic regression model was developed to determine independent predictors
of in-hospital mortality using the 2005 dataset. The model was then applied to the
2006 dataset to determine the generalizability of the predictors.
Results
Significant independent predictors of in-hospital mortality in 2005 included age 85
years or older (adjusted odds ratio [OR], 2.53; 95% confidence interval [CI], 1.21–5.30;
P=.013), acute respiratory failure (adjusted OR, 5.67; 95% CI, 3.51–9.17; P < .0001), septicemia (adjusted OR, 4.63; 95% CI, 3.08–6.96; P < .0001), and acute renal failure (adjusted OR, 2.11; 95% CI, 1.30–3.41; P=.002). The following baseline characteristics also predicted in-hospital mortality
in 2006: age 85 years or older (adjusted OR, 2.45; 95% CI, 1.31–4.59; P=.005), acute respiratory failure (adjusted OR, 7.11; 95% CI, 4.46–11.33; P < .0001), septicemia (adjusted OR, 3.91; 95% CI, 2.64–5.80; P < .0001), and acute renal failure (adjusted OR, 2.75; 95% CI, 1.82–4.15; P < .0001). Chronic morbidities were not associated with in-hospital mortality.
Conclusion
Among hospitalized NH residents, age 85 years or older and several acute conditions,
but not chronic morbidities, predicted in-hospital mortality. Elderly NH residents
at risk of developing these acute conditions may benefit from palliative care.
Keywords
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Article info
Publication history
Published online: November 26, 2009
Footnotes
The authors have no conflicts of interest relating to this article.
Dr. Ali Ahmed is supported by the National Institutes of Health through grants (R01-HL085561 and R01-HL097047) from the National Heart, Lung, and Blood Institute and a generous gift from Ms. Jean B. Morris of Birmingham, Alabama.
Identification
Copyright
Published by Elsevier Inc.
