Characteristics and determinants of survival in oldest old nursing home residents admitted to hospital with an acute illness compared to their younger counterparts.
OBJECTIVE
The clinical problems and needs of our oldest old (≥85 years) are often substantially different from those of younger patients, and are arguably different from younger elderly patients (age 65-84). With the increasing number of frail oldest olds residing in Nursing Homes (NH), we aim to identify differences in prognostic indicators and outcomes in this age group compared to younger NH residents.


METHODS
We retrospectively identified all consecutive admissions from NHs to an Acute Medical Assessment Unit between January 2005 and December 2007. Admission prognostic indicators and outcomes at follow-up were compared between younger (<85) and older (≥85) age groups. Using multiple regression methods controlling for potential confounders, we compared in-hospital mortality and long-term survival after discharge between the groups.


RESULTS
Three hundred and sixteen patients (mean age 84.3, SD 8.34 years) were included (68 % females). Admission characteristics were mostly similar between age groups. In-hospital mortality rates were not significantly different between groups, even after adjusting for possible confounders. Oldest old patients had a significantly greater hazard of dying after discharge (HR 1.37; 1.03-1.83) compared to the younger group after removing explanatory variables with more than 5 % missing data.


CONCLUSIONS
Whilst the admission characteristics are similar between younger and older patients from NHs, there is evidence to suggest worse long-term survival prospects for oldest old patients.
Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, Norfolk, NR4 7UY, UK, katiehonney@hotmail.com.
Katie
K
Honney
Nicola J B
NJ
Trepte
Richard A
RA
Parker
Jasmine
J
Patel
Robert
R
Mallinson
Sayed J
SJ
Sultanzadeh
John F
JF
Potter
Phyo Kyaw
PK
Myint
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006707:Homes for the Aged; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology