To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents.
Retrospective analysis of the public-use copies of the 2005–2006 National Hospital Discharge Survey (NHDS) datasets.
Non-federal acute-care, short-stay hospitals in all 50 states and the District of Columbia.
Participants were 1904 and 1752 NH residents, 45 years or older, hospitalized in 2005 and 2006, respectively.
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.
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.
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.
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Published online: November 26, 2009
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.
Published by Elsevier Inc.