title: In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study.
abstract: BACKGROUND
  Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended.
  
  
  OBJECTIVE
  To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses.
  
  
  METHODS
  Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis.
  
  
  RESULTS
  In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % (R2) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969).
  
  
  CONCLUSIONS
  Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.
authors.affiliation: Azienda per i Servizi Sanitari Trento, Via Alcide Degasperi 79, 38123, Trento, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ambrosi
authors.affiliation: Azienda Ospedaliera Carlo Poma, Strada Lago Paiolo 10, 46100, Mantua, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Togni
authors.affiliation: Azienda per i Servizi Sanitari Trento, Via Alcide Degasperi 79, 38123, Trento, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guarnier
authors.affiliation: Azienda per i Servizi Sanitari Trento, Via Alcide Degasperi 79, 38123, Trento, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barelli
authors.affiliation: Azienda per i Servizi Sanitari Trento, Via Alcide Degasperi 79, 38123, Trento, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zambiasi
authors.affiliation: Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani 1, 37122, Verona, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Allegrini
authors.affiliation: Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, 25124, Brescia, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bazoli
authors.affiliation: Azienda ULSS 9 Treviso, Via Sant'Ambrogio di Fiera 37, 31100, Treviso, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Casson
authors.affiliation: Azienda per l'Assistenza Sanitaria n. 2 Bassa Friulana-Isontina, Via Vittorio Veneto 174, 34170, Gorizia, Italy.
authors.forename: Meri
authors.initials: M
authors.lastname: Marin
authors.affiliation: Azienda ULSS n. 6 Vicenza, Viale Rodolfi 37, 36100, Vicenza, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Padovan
authors.affiliation: Azienda per l'Assistenza Sanitaria n.4 Friuli Centrale, Via Pozzuolo 330, 33100, Udine, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Picogna
authors.affiliation: Istituto Ortopedico Rizzoli, Via Alessandro Codivilla 9, 40136, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Taddia
authors.affiliation: Fondazione Zancan, Via del Vescovado 66, 35141, Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Salmaso
authors.affiliation: Bologna University, Via Zamboni 33, 40126, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Azienda Ospedaliero-Universitaria, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frison
authors.affiliation: Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani 1, 37122, Verona, Italy.
authors.forename: Oliva
authors.initials: O
authors.lastname: Marognolli
authors.affiliation: Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani 1, 37122, Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Canzan
authors.affiliation: Verona University, Via dell'Artigliere 8, 37129, Verona, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
authors.affiliation: Udine University, Viale Ungheria 20, 33100, Udine, Italy. alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality* / Q000451:nursing; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D011446:Prospective Studies
keywords: Elderly; Hospital mortality; Internal medicine; Longitudinal studies; Risk factors