Indicateurs précoces de durée de séjour prolongée chez les sujets âgés

Objectives > The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients. Methods > This prospective pilot study conducted at Strasbourg University Hospital, included patients aged 75 years of older who were hospitalized via the emergency deportment (SAFES cohort: Sujet Age Fragile: Evaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG). Results > The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with G mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay regardless of the definition of prolonged stay No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A "risk of malnutrition" (OR = 14.07) and "mood disorders" (OR = 2,5) were both early markers for prolonged hospitalization. Although not statistically significant I walking difficulties" (OR = 2.72) and "cognitive impairment" (OR = 5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz Activities of Doily Living Index or its course during hospitalization. Conclusion > our study shows that when generally recognized indicators of frailty ore token into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.