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In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study

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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.

Aims

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 % (R 2) 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.

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Acknowledgments

The researchers would like to thank both the patients and the clinical teams of the involved hospitals for their participation in the research process.

Author information

Authors and Affiliations

  1. Azienda per i Servizi Sanitari Trento, Via Alcide Degasperi 79, 38123, Trento, Italy

    Elisa Ambrosi, Annamaria Guarnier, Paolo Barelli & Paola Zambiasi

  2. Azienda Ospedaliera Carlo Poma, Strada Lago Paiolo 10, 46100, Mantua, Italy

    Stefano De Togni

  3. Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani 1, 37122, Verona, Italy

    Elisabetta Allegrini, Oliva Marognolli & Federica Canzan

  4. Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, 25124, Brescia, Italy

    Letizia Bazoli

  5. Azienda ULSS 9 Treviso, Via Sant’Ambrogio di Fiera 37, 31100, Treviso, Italy

    Paola Casson

  6. Azienda per l’Assistenza Sanitaria n. 2 Bassa Friulana-Isontina, Via Vittorio Veneto 174, 34170, Gorizia, Italy

    Meri Marin

  7. Azienda ULSS n. 6 Vicenza, Viale Rodolfi 37, 36100, Vicenza, Italy

    Marisa Padovan

  8. Azienda per l’Assistenza Sanitaria n.4 Friuli Centrale, Via Pozzuolo 330, 33100, Udine, Italy

    Michele Picogna

  9. Istituto Ortopedico Rizzoli, Via Alessandro Codivilla 9, 40136, Bologna, Italy

    Patrizia Taddia

  10. Fondazione Zancan, Via del Vescovado 66, 35141, Padua, Italy

    Daniele Salmaso

  11. Bologna University, Via Zamboni 33, 40126, Bologna, Italy

    Paolo Chiari

  12. Azienda Ospedaliero-Universitaria, Via Giustiniani 2, 35128, Padua, Italy

    Tiziana Frison

  13. Verona University, Via dell’Artigliere 8, 37129, Verona, Italy

    Luisa Saiani

  14. Udine University, Viale Ungheria 20, 33100, Udine, Italy

    Alvisa Palese

Authors
  1. Elisa Ambrosi
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  2. Stefano De Togni
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  3. Annamaria Guarnier
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  4. Paolo Barelli
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  5. Paola Zambiasi
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  6. Elisabetta Allegrini
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  7. Letizia Bazoli
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  8. Paola Casson
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  9. Meri Marin
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  10. Marisa Padovan
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  11. Michele Picogna
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  12. Patrizia Taddia
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  13. Daniele Salmaso
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  14. Paolo Chiari
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  15. Tiziana Frison
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  16. Oliva Marognolli
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  17. Federica Canzan
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  18. Luisa Saiani
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  19. Alvisa Palese
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Corresponding author

Correspondence to Alvisa Palese.

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The authors confirm that there are no conflicts of interest.

Ethical approval

Ethical approval was granted by the Clinical Research Ethics Committee of Verona University Hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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The authors received no financial support for the research, authorship and/or publication of this article.

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Ambrosi, E., De Togni, S., Guarnier, A. et al. In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study. Aging Clin Exp Res 29, 517–527 (2017). https://doi.org/10.1007/s40520-016-0576-8

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  • DOI: https://doi.org/10.1007/s40520-016-0576-8

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