title: Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study.
abstract: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality from discharge to 30 days post-discharge.
  
  
  
  retrospective analysis of Dutch hospital and mortality data collected between 2000 and 2010.
  
  
  
  the participants included 263,746 people, aged 65 years and above, who were acutely admitted for acute myocardial infarction (AMI), heart failure (HF), stroke, chronic obstructive pulmonary disease, pneumonia or hip fracture.
  
  
  
  we compared changes in the in-hospital mortality and mortality from discharge to 30 days post-discharge in the Netherlands using a logistic- and a multinomial regression model.
  
  
  
  for all six diagnoses, the mortality from admission to 30 days post-discharge declined between 2000 and 2009. The decline ranged from a relative risk ratio (RRR) of 0.41 [95% confidence interval (CI) 0.38-0.45] for AMI to 0.77 [0.73-0.82] for HF. In separate analyses, the in-hospital mortality decreased for all six diagnoses. The mortality from discharge to 30 days post-discharge in 2009 compared to 2000 depended on the diagnosis, and either declined, remained unchanged or increased.
  
  
  
  the decline in hospital mortality in acutely admitted older patients was largely attributable to the lower in-hospital mortality, while the change in the mortality from discharge to 30 days post-discharge depended on the diagnosis. Separately reporting the two rate estimates might be more informative than providing an overall hospital mortality rate.
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Marjon
authors.initials: M
authors.lastname: van Rijn
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Janet L
authors.initials: JL
authors.lastname: MacNeil-Vroomen
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Suijker
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.affiliation: University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010343:Patient Admission / Q000639:trends; D010351:Patient Discharge / Q000639:trends; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: 30-day post-discharge mortality; acutely admitted older patients; in-hospital mortality; older people