title: [Co-morbidity in acutely hospitalised older patients as a risk factor for death in hospital or within 3 months after discharge].
abstract: OBJECTIVE
  To study the presence of co-morbidity and delirium and to determine whether these factors are predictors of hospital and shortterm mortality in elderly patients acutely admitted to a department of internal medicine.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Social and demographic data as well as data on their physical and cognitive limitations were collected from consecutive patients of 65 years and older who were hospitalised in the period from I December 2002 to 30 June 2005 in the Academic Medical Centre in Amsterdam, the Netherlands. Co-morbidity and ICD diagnosis were determined on discharge from the hospital. Three months after discharge the patients' circumstances were assessed.
  
  
  RESULTS
  A total of 461 patients, 195 men and 266 women with an average age of 78.2 years (SD: 7.8), were included. Of these patients, 132 (28.6%) had cognitive impairment and the mean number of limitations with regard to the activities of daily living (ADL) was 5.48 (10.4%) patients died in hospital and another 74 patients (16.1%) had died 3 months after discharge. The only independent predictor of hospital mortality was delirium at admission (OR: 2.28; 95% CI: 1.23-4.21). Independent risk factors for mortality within 3 months after discharge were: delirium at admission (OR: 2.20; 95% CI: 1.12-4.31), pre-admission ADL limitations (OR: 1.11; 95% CI: 1.02-1.21), a diagnosed malignancy (OR: 5.96; 95% CI: 2.45-14-52), and a higher Charlson co-morbidity index (OR: 1.19; 95% CI: 1.04-1-34).
  
  
  CONCLUSIONS
  At discharge from the hospital, the risk of death within 3 months after discharge in acutely hospitalised patients of 65 years and older was determined by a combination of delirium at admission, pre-admission ADL limitations, a malignancy, and co-morbidity. These results can be used to identify elderly patients who might benefit from comprehensive geriatric assessment during hospitalisation and from a well-prepared discharge planning that takes their co-morbidity into consideration.
authors.affiliation: Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.700, 1100 DE Amsterdam. s.e.derooij@amc.uva.nl
authors.forename: S E
authors.initials: SE
authors.lastname: de Rooij
authors.forename: B M
authors.initials: BM
authors.lastname: Buurman
authors.forename: J C
authors.initials: JC
authors.lastname: korevaar
authors.forename: B C
authors.initials: BC
authors.lastname: Van Munster
authors.forename: M J
authors.initials: MJ
authors.lastname: Schuurmans
authors.forename: A M
authors.initials: AM
authors.lastname: Laqaaij
authors.forename: H J J
authors.initials: HJ
authors.lastname: Verhaar
authors.forename: M
authors.initials: M
authors.lastname: Levi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D005852:Geriatric Psychiatry; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index