Abstract
Background
Older people face the biggest challenges in the overburdened healthcare services in Nigeria especially when hospitalized. There is no reliable data on the predictors of mortality in this population.
Aims
To determine the predictors of mortality among older patients on admission in the medical wards of University College Hospital, Ibadan.
Methods
Using a prospective cohort design, we investigated 450 patients (> 60 years) from the day of admission to death or discharge. Variables assessed included sociodemographic, family dynamics, lifestyle habits, healthcare utilization, quality of life, frailty, anxiety, depression, cognition, functional disability and anthropometric parameters. Kaplan–Meier method and Log-rank test were used to estimate and compare survival functions, respectively. Cox proportional hazard regression analysis was used to determine the predictors of mortality.
Results
The mean age of the subjects was 71.5 ± 8.0 years and 234 (52.0%) were females. Overall, there were 99 (22.0%) in-hospital deaths. The median survival time (MST) was 36.0 ± 3.0 days [females = 40.0 ± 3.5 days vs males = 31.0 ± 4.5 days (p < 0.001)]. There was a significant negative correlation between MST and age (r = − 0.931). Predictors of mortality on Cox’s proportional hazard regression analyses were male sex HR = 2.03 (95% CI 1.27–3.24), severe frailty HR = 2.07 (1.02–4.20), cognitive impairment HR = 1.90 (1.14–3.17) and having ≥ 5 morbidities HR = 1.94 (1.14–3.30).
Conclusion
There was a high mortality among older patients particularly the frail, male or those with multiple morbidities. Prompt and holistic management of morbidities and targeted interventions for cognitive impairment and frailty are needed to improve survival during hospitalization.
Similar content being viewed by others
References
Maia FDO, Duarte YA, Lebrão ML et al (2006) Risk factors for mortality among elderly people. Rev Saude Publica 40:1049–1056. https://doi.org/10.1590/S0034-89102006005000009
Adebusoye LA, Ladipo MM, Owoaje ET et al (2011) Morbidity pattern amongst elderly patients presenting at a primary care clinic in Nigeria. Afr J Prim Health Care Fam Med 3:355–360. https://doi.org/10.1080/20786204.2011.10874114
Adebusoye LA, Owolabi MO, Kalula S et al (2015) All-cause mortality among elderly patients admitted to the medical wards of hospitals in Africa: a systematic review. Niger J Health Sci 15:45–51. https://doi.org/10.4103/1596-4078.171372
Silva TJA, Jerussalmy CS, Farfel JM et al (2009) Predictors of in-hospital mortality among older patients. Clinics (Sao Paulo) 64:613–618. https://doi.org/10.1590/S1807-59322009000700002
Nakajima N, Aiba M, Fukuda Y et al (2009) Causes of death in hospitalized elderly patients. Nihon Ronen Igakkai Zasshi 46:71–78
Sanya E, Akande T, Opadijo G et al (2008) Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin. Afr J Med Med Sci 37:375–381
Onwuchekwa AC, Asekomeh EG (2009) Geriatric admissions in a developing country: experience from a tertiary centre in Nigeria. Ethn Dis 19:359–362
Naidoo A (2009) Trends in adult medical admissions at Tambo Memorial Hospital, Gauteng, between 2005 and 2007. Dissertation, University of the Witwatersrand
Sanya E, Kolo P, Adekeye K et al (2011) Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria. Ann Afr Med 10:278–283. https://doi.org/10.4103/1596-3519.87043
Myer L, Smith E, Mayosi BM (2013) Medical inpatient mortality at Groote Schuur Hospital, Cape Town, 2002–2009. South African Med J 103:28–35. https://doi.org/10.7196/SAMJ.6285
National Population Commission (2010) Population Distribution by Sex, State, LGA & Senatorial District. 2006 Popul Hous Census III:1–64
Paraïso MN, Houinato D, Guerchet M et al (2010) Validation of the use of historical events to estimate the age of subjects aged 65 years and over in Cotonou (Benin). Neuroepidemiology 35:12–16. https://doi.org/10.1159/000301715
Ogunniyi A, Osuntokun BO (1993) Determination of ages of elderly Nigerians through historical events: validation of Ajayi-Igun 1963 listing. West Afr J Med 12:189–190
Smilkstein G (1978) The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract 6:1231–1239
Nzeagwu O, Uwaegbute A (2010) Assessment of nutritional vulnerability of the elderly using mini nutritional assessment (MNA) tool. Niger J Nutr Sci 31:39–47. https://doi.org/10.4314/njns.v31i2.63914
Adebusoye LA, Ajayi IO, Dairo MD et al (2012) Nutritional status of older persons presenting in a primary care clinic in Nigeria. J Nutr Gerontol Geriatr 31:71–85. https://doi.org/10.1080/21551197.2012.647560
Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65
Stafford L, Berk M, Jackson HJ (2007) Validity of the hospital anxiety and depression scale and patient health questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 29:417–424. https://doi.org/10.1016/j.genhosppsych.2007.06.005
Callahan CM, Unverzagt FW, Hui SL et al (2002) Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care 40:771–781. https://doi.org/10.1097/01.MLR.0000024610.33213.C8
Wee CC, Davis RB, Hamel MB (2008) Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes 6:11–17. https://doi.org/10.1186/1477-7525-6-11
Ogunlana MO, Dada OO, Oyewo OS et al (2014) Quality of life and burden of informal caregivers of stroke survivors. Hong Kong Physiother J 3:6–12. https://doi.org/10.1016/j.hkpj.2013.11.003
Akosile CO, Okoye EC, Nwankwo MJ et al (2011) Quality of life and its correlates in caregivers of stroke survivors from a Nigerian population. Qual Life Res 20(9):1379–1384. https://doi.org/10.1016/j.hkpj.2013.11.003
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495. https://doi.org/10.1503/cmaj.050051
World Health Organisation (1995) Physical status: the use and interpretation of anthropometry: report of a WHO expert committee. World Health Organ Tech Rep Ser 854:1–452
Walters SJ (2009) What is a Cox model? Survival (Lond):1–8. http://www.whatisseries.co.uk
Nyaruhucha CN, Msuya JM, Augustino B (2001) Health status of hospitalised elderly in Morogoro Regional Hospital. East Afr Med J 78:489–492
Holahan CJ, Schutte KK, Brennan PL et al (2010) Late-life alcohol consumption and 20-year mortality. Alcohol Clin Exp Res 34:1961–1971. https://doi.org/10.1111/j.1530-0277.2010.01286.x
Fadare JO, Agboola SM, Opeke OA et al (2013) Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag 9:115–120. https://doi.org/10.2147/TCRM.S40120
Eze UIH, Olowo AO (2011) Prescribing patterns and inappropriate use of medications in elderly outpatients in a tertiary hospital in Nigeria. Trop J Pharm Res 10:19–25
Benyamini Y, Blumstein T, Lusky A et al (2003) Gender differences in the self-rated health-mortality association: is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival? Gerontologist 43:396–405. https://doi.org/10.1093/geront/43.3.396
Maggio M, Dall’Aglio E, Lauretani F et al (2012) The hormonal pathway to cognitive impairment in older men. J Nutr Health Aging 16:40–54
Le Maguet P, Roquilly A, Lasocki S et al (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensiv Care Med 40:674–682. https://doi.org/10.1007/s00134-014-3253-4
Fried LP, Ferrucci L, Darer J et al (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:255–263
Cano C, Samper-Ternent R, Al Snih S et al (2012) Frailty and cognitive impairment as predictors of mortality in older Mexican Americans. J Nutr Health Aging 16:142–147. https://doi.org/10.1016/j.biotechadv.2011.08.021
Nunes BP, Flores TR, Mielke GI et al (2016) Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr Nov-Dec 67:130–138. https://doi.org/10.1016/j.archger.2016.07.008
Smith SM, Soubhi H, Fortin M et al (2012) Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. https://doi.org/10.1136/bmj.e5205
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
The University of Ibadan/University College Hospital Institutional Ethical Review Board (UI/UCH ERB) approved this research (reference number: UI/EC/12/0092).
Informed consent
Informed consent was obtained from all individual participants included in this study.
Rights and permissions
About this article
Cite this article
Adebusoye, L.A., Owolabi, M. & Ogunniyi, A. Predictors of mortality among older patients in the medical wards of a tertiary hospital in Nigeria. Aging Clin Exp Res 31, 539–547 (2019). https://doi.org/10.1007/s40520-018-0997-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-018-0997-7