Mortality one-year postdischarge from a Veterans Affairs geriatric evaluation and management unit: assessing mortality risks.
OBJECTIVE
To assess at Geriatric Evaluation and Management Unit (GEM) admission factors that affect mortality 12-months postdischarge and to develop a preliminary risk scoring protocol to guide targeting of GEM care.


METHODS
A 24 bed-GEM at a Veterans Affairs (VA) Medical Center.


METHODS
Relative risks (RR) were assessed using prospective data; a risk protocol from 1988-1989 data was tested on 1990-1991 patients.


METHODS
A total of 283 male patients, aged 60 to 102, discharged over 4 years.


RESULTS
Age at GEM admission did not correlate with death (r = .14; P = .145), but did correlate with risk scores (r = .33, P < .001). The risk protocol had a sensitivity of .67 and specificity of 1.00. High and low risk patients had mortalities of 51% versus 20%, a Wilcoxon (Gehan) statistic of 15.22, df = 1, and P < .001. Differences in mortality ceased about 100 days postdischarge. Three univariate RR exceeded 1.00 at a 99% Confidence Interval (CI): IADL score (RR: 1.12; CI, 1.03-1.21); nursing acuity score (RR: 1.78; CI: 1.02-3.11); and a primary diagnosis of pneumonia/sepsis (RR: 3.95; CI, 1.60-9.78). Four RRs exceeded 1.00 at a 90% CI: dementia (RR: 1.78; CI, 1.02-3.09); transfer into the GEM from a medical service (RR: 1.47; CI, 1.02-2.12); deconditioning/functional decline (RR: 1.67; CI, 1.12-2.48); and use of a Foley catheter (RR: 2.22; CI, 1.11-4.45). Thirteen other potential risk factors were found in a multivariate analysis.


CONCLUSIONS
The point estimates of risk factors may help clinicians target GEM care, but the development of a useable risk protocol requires additional work. Causal models may be needed to assess patient conditions related to successful treatment in GEMs.
Cookingham Institute of Public Affairs, University of Missouri at Kansas City, 64110-2499, USA.
A R
AR
Williams
J M
JM
Meuleman
M M
MM
Shaw
D000368:Aged; D000369:Aged, 80 and over; D016002:Discriminant Analysis; D005431:Florida / Q000453:epidemiology; D015577:Geriatric Assessment; D006757:Hospital Units; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009730:Nursing Assessment; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs