title: Six-month outcome of elderly people hospitalized via the emergency department: the SAFES cohort.
abstract: BACKGROUND
  The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization.
  
  
  METHODS
  A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period.
  
  
  RESULTS
  Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR=1.83; 95% CI=1.27-2.62) or a higher number of children (HR=0.86; 95% CI=0.78-0.96), balance problems (HR=1.72; 95% CI=1.19-2.47), malnutrition or risk thereof (HR=1.93; 95% CI=1.24-3.01), and dementia syndrome (HR=1.88; 95% CI=1.32-2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR=1.92; 95% CI=1.17-3.16), delirium (HR=1.80; 95% CI=1.24-2.62), and a high level of comorbidity (HR=1.62; 95% CI=1.09-2.40). Institutionalization (HR=1.92; 95% CI=1.37-2.71) and unplanned readmission (HR=4.47; 95% CI=3.16-2.71) within the follow-up period were also found as independent predictors.
  
  
  CONCLUSIONS
  The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects' prognosis favorably.
authors.affiliation: Université de Reims Champagne-Ardenne, faculté de médecine, EA 3797, 51, rue Cognacq-Jay, 51095 Reims cedex, France. mdrame@chu-reims.fr
authors.forename: M
authors.initials: M
authors.lastname: Dramé
authors.forename: P O
authors.initials: PO
authors.lastname: Lang
authors.forename: J-L
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authors.lastname: de Wazières
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authors.lastname: Gonthier
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authors.lastname: Ankri
authors.forename: O
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authors.lastname: Saint-Jean
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mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D013997:Time Factors