[Early indicators of prolonged hospitalization of the elderly: pilot study at Strasbourg University Hospital].
OBJECTIVE
The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients.


METHODS
This prospective pilot study, conducted at Strasbourg University Hospital, included patients aged 75 years or older who were hospitalized via the emergency department (SAFES cohort: Sujet Agé Fragile: Evaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG).


RESULTS
The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with a mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A "risk of malnutrition" (OR=14.07) and "mood disorders" (OR=2,5) were both early markers for prolonged hospitalization. Although not statistically significant, "walking difficulties" (OR=2.72) and "cognitive impairment" (OR=5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz's Activities of Daily Living Index or its course during hospitalization.


CONCLUSIONS
Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.
Lang
Pierre-Olivier
PO
Département de Réhabilitation et Gériatrie, Hôpital des Trois-Chêne, Hôpitaux universitaires de Genève, Thonex-Genève, Suisse. Pierre.O.Lang@hcuge.ch
Heitz
Damien
D
Meyer
Nicolas
N
Dramé
Moustapha
M
Jovenin
Nicolas
N
Ankri
Joël
J
Somme
Dominique
D
Novella
Jean-Luc
JL
Gauvain
Jean-Bernard
JB
Colvez
Alain
A
Couturier
Pascal
P
Lanièce
Isabelle
I
Voisin
Thierry
T
de Wazières
Benoit
B
Gonthier
Régis
R
Jeandel
Claude
C
Jolly
Damien
D
Saint-Jean
Olivier
O
Blanchard
François
F
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D016138:Walking