Zafrir Barak, Laor Arie, Bitterman Haim
Department of Internal Medicine, Carmel Medical Center, Haifa, Israel.
Isr Med Assoc J. 2010 Jan;12(1):10-5.
Parallel to increased life expectancy, the number of very elderly patients hospitalized in internal medicine departments is growing rapidly, although clinical data on hospital care are lacking.
To investigate the sociodemographic data, hospitalization characteristics and outcomes of nonagenarian patients, as these measures are necessary for evaluating prognostic information and predictors of mortality.
We reviewed the medical records of all patients aged > or = 90 hospitalized in our institute's Department of Internal Medicine. The data comprised 482 admissions of 333 patients hospitalized over a one year period.
Half of the study patients were residents of nursing institutions. A high rate of atrial fibrillation was documented (106 patients, 32%). Acute infectious diseases constituted the leading diagnosis (276/482 admissions, 57%), followed by acute coronary syndrome (17% of admissions). In-hospital mortality occurred in 74 patients (22%). Chronic therapy with statins or acetylsalicylic acid was inversely related to mortality (P<0.05). The main predictors for in-hospital death of nonagenarians were pressure sores, older age, atrial fibrillation, malignant disease, and admission due to an acute infection, especially Clostridium difficile-associated diseases in addition, mental decline, permanent urinary catheter, leukocytosis, renal failure and hypoalbuminemia predicted post-discharge mortality. Admission due to an infectious disease but not acute coronary syndrome was significantly correlated to in-hospital and post-discharge mortality (P<0.001).
Hospitalized nonagenarians comprise a growing group with distinct characteristics and increasing significance in the daily practice of internal medicine departments. Comprehensive assessment of the elderly at admission together with identification of the above clinical and laboratory risk factors for mortality will help determine in-hospital management, discharge planning and rehabilitation programs.
随着预期寿命的增加，内科住院的高龄患者数量迅速增长，尽管缺乏关于医院护理的临床数据。
调查非agenarian患者的社会人口统计学数据、住院特征和结局，因为这些措施对于评估预后信息和死亡预测因素是必要的。
我们回顾了我院内科住院的所有年龄≥90岁患者的病历。数据包括一年内住院的333例患者的482次入院情况。
一半的研究患者是护理机构的居民。记录到房颤发生率较高（106例患者，32%）。急性传染病是主要诊断（276/482次入院，57%），其次是急性冠状动脉综合征（17%的入院患者）。74例患者（22%）发生院内死亡。他汀类药物或乙酰水杨酸的长期治疗与死亡率呈负相关（P<0.05）。非agenarian患者院内死亡的主要预测因素是压疮、高龄、房颤、恶性疾病以及因急性感染入院，尤其是艰难梭菌相关疾病。此外，精神衰退、永久性导尿管、白细胞增多、肾衰竭和低白蛋白血症预测出院后死亡率。因传染病而非急性冠状动脉综合征入院与院内和出院后死亡率显著相关（P<0.001）。
住院的非agenarian患者构成了一个不断增长的群体，在内科日常实践中具有独特的特征且重要性日益增加。入院时对老年人进行全面评估以及识别上述临床和实验室死亡风险因素将有助于确定院内管理、出院计划和康复方案。
