Skip to main content
SpringerLink
Log in

Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people?

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Identification of optimal predictors of the 5.5-year survival in former geriatric inpatients.Investigation of the direction and shape of the relationship between mortality risk and its predictors.

Design

Retrospective survival analysis with the application of the Cox proportional hazards model.

Setting

Teaching geriatric unit.

Participants

478 inpatients (mean age 77.9; +6.8) discharged from geriatric ward during year 2008, without any exclusion criteria.

Measurements

Comprehensive geriatric assessment of numerous health variables, body mass index (BMI), clinical and biochemical findings, and outcomes of the final diagnosis. Records on the dates of deaths were obtained from the Provincial Office of Population Register.

Results

During the 5.5-year follow-up 209 (43.7%) patients died. In the multivariate setup, six risk factors with an independent impact on mortality were identified: age (p=0.036), cognitive functioning on the Blessed test (p=0.005), score on instrumental ADL (p<0.0001), score on Charlson comorbidity index (p<0.0001), cholesterol level (p<0.0001), BMI (p<0.0001), and hemoglobin level (p=0.02). The latter two predictors exhibited a significant inverted J-shaped association with mortality, i.e., considerably higher risk of death corresponds to the lower values of these variables in comparison to their higher levels.

Conclusion

Older age, worse IADL and cognitive functioning, and higher comorbidity were recognized as endangering one’s long-term survival. On the other hand, moderate obesity (BMI 36), higher cholesterol and the absence of anemia (hemoglobin 13.6 g/dL) are associated with longer survival. Therefore, irrespective of the individualized treatment and physical exercise, nutrient-dense food seems to be a key recommendation to prevent frailty or malnutrition in the oldest and comorbid population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mladovsky P, Allin S, Masseria C, Hernández-Quevedo C, McDaid D, Mossialos E. Health in European Union: Trends and analysis. European Observatory on Health Systems and Policies. Observatory Studies Series no.19, 2009

    Google Scholar 

  2. Christensen K, Doblhammer G, Rau R, Vaupel J. Ageing populations: the challenges ahead. Lancet 2009;374:1196–1208

    Article  PubMed Central  PubMed  Google Scholar 

  3. Rechel B, Grundy E, Robine J-M, Cylus J, Mackenbach JP, Knai C, McKee M. Ageing in the European Union. Lancet 2013;381:1312–22

    Article  PubMed  Google Scholar 

  4. Fried LP, Ferrucci L, Darer J. Williamson JD, Anderson G. Untangling the concept of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255–263

    Article  PubMed  Google Scholar 

  5. Van Craen CK, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, Boonen S, Gosset C, Petermans J, Milisen K. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc 2010;58:83–92

    Article  PubMed  Google Scholar 

  6. Matzen LE, Jepsen DB, Ryg J, Masud T. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit. BMC Geriatrics 2012;12:32

    Article  PubMed Central  PubMed  Google Scholar 

  7. Park MH, Kwon DY, Jung JM, Han C, Jo I, Jo SA. Mini-Mental Status Examination as predictors of mortality in the elderly. Acta Psychiatr Scand 2013;127:298–304

    Article  CAS  PubMed  Google Scholar 

  8. Cruz-Oliver DM, Malmstrom TK, Allen CM, Tumosa N, Morley JE. The Veterans Affairs Saint Luis University mental status exam (SLUM EXAM) and the mini-mental status exam as predictors of mortality and institutionalization. J Nutr Health Aging 2012;16:636–641

    Article  CAS  PubMed  Google Scholar 

  9. Shamliyan T, Talley KMC, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Aging Res Rev 2013.12:719–736

    Article  Google Scholar 

  10. Iwata M, Kuzuya M, Kitagawa Y, Suzuki Y. Underappreciated predictors for postdischarge mortality in acute hospitalized oldest-old patients. Gerontology 2006;52:92–98

    Article  PubMed  Google Scholar 

  11. Conde-Martel A, Hemmersbach-Miller M, Marchena-Gomez J, Saavedra-Santana P, Betancor-Leon P. Five-year survival and prognostic factors in a cohort of hospitalized nonagenarians. Eur J Inter Med 2012;23:513–518

    Article  Google Scholar 

  12. De Ruijter W, Westendorp RGJ, Assendelft WJJ, den Elzen WPJ, de Craen AJM, Cessie S, Jacobijn Gussekloo J. Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ 2009;338:a3083 doi:10.1136/bmj.a3083

    Article  PubMed Central  PubMed  Google Scholar 

  13. Szewieczek J, Dulawa J, Gminski J, Kurek A, Legierska K, Francuz T, Wlodarczyk-Sporek I, Janusz-Jenczen M, Hornik B. Better cognitive and physical performance is associated with higher blood pressure in centenarians. J Nutr Health Aging 2011;15:618–622

    Article  CAS  PubMed  Google Scholar 

  14. Bouillanne O, Dupont-Belmont C, Hay P, Hamon-Vilcot B, Cynober L, Aussel C. Fat mass protects hospitalized elderly persons against morbidity and mortality. Am J Clin Nutr 2009;90(3):505–510

    Article  CAS  PubMed  Google Scholar 

  15. Chiang PH, Liu MH, Peng LN, Chen LK, Chen JD, Hou SM. Survival benefits of metabolic syndrome among older men aged 75 years and over in Taivan, J Nutr Health Aging 2012;16:520–524

    Article  CAS  PubMed  Google Scholar 

  16. Batsis JA, Singh S, Lopez-Jimenez F. Anthropometric measurements and survival in older Americans: Results from the Third National Health and Nutrition Examination Survey. J Nutr Health Aging 2014; 18:123–130

    Article  CAS  PubMed  Google Scholar 

  17. Hainer V, Aldhoon-Hainerova I. Obesity paradox does exist. Diabetes Care 2013;36, Suppl.2.:S276–S281

    Article  PubMed Central  PubMed  Google Scholar 

  18. Cereda E, Pedrolli C, Zagami A, Vanotti A, Piffer S, Opizzi A, Rondanelli M, Caccialanza R. Body mass Index and mortality in institutionalized elderly. J Am Med Dir Assoc 2011;12:174–178

    Article  PubMed  Google Scholar 

  19. Veronese N, De Rui M, Toffanello ED, et al. Body Mass Index a predictor of all-cause mortality in nursing home residents during a 5-year follow-up. J Am Med Dir Assoc 2013;14:53–57

    Article  PubMed  Google Scholar 

  20. Kaiser R, Winning K, Uter W, Volkert D, Lesser S, Stehle P, Kaiser MJ, Sieber CC, Bauer JM. Functionality and mortality in obese nursing home residents: An example of ‘risk factor paradox’? J Am Med Dir Assoc 2010;11:428–435

    Article  PubMed  Google Scholar 

  21. Vischer UM, Safar ME, Safar H, Iaria P, Le Dudal K, Henry O, Herrmann FR, Ducimetiere P, Blacher J. Cardiometabolic determinants of mortality in geriatric population: is there a ‘reverse metabolic syndrome’? Diabetes Metab 2009;35:108–114

    Article  CAS  PubMed  Google Scholar 

  22. Chen Z, Yang G, Offer A, Zhou M, Smith M, Peto R, Ge H, Yang L, Whitlock G. Body mass index and mortality in China: a 15-year prospective study of 220000 men. Int J Epidemiol 2012;41(2):472–481

    Article  PubMed  Google Scholar 

  23. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013;309 (1):71–82

    Article  CAS  PubMed  Google Scholar 

  24. Petursson H, Sigursson JA, Bengtsson C, Nilsen TIL, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norvegian HUNT 2 study. J Eval Clin Pract 18:159–168

  25. Tuikkala P, Hartikainen S, Korhonen MJ, Lavikainen P, Kettunen R, Sulkava R, Enlund H. Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up. Scand J Prim Health Care 2010;28:121–127

    Article  PubMed Central  PubMed  Google Scholar 

  26. Weiss A, Beloosesky Y, Schmilovitz-Weiss H, Grossman E, Boaz M. Serum total cholesterol: A mortality predictor in elderly hospitalised patients. Clinical Nutrition 2013;32:533–537

    Article  CAS  PubMed  Google Scholar 

  27. Mahmood S, Levy D, Vasan RS, Wang T. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective, 2013. http://dx.doi.org/10.1016/S0140-6736(13)61752-3

    Google Scholar 

  28. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood 2006;107:3841–6.

    Article  CAS  PubMed  Google Scholar 

  29. Rubenstein LZ, Wieland D, Bernabei R, Eds. Geriatric assessment technology. Milan: Kurtis, 1995

    Google Scholar 

  30. Mahoney YF, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14:61–65

    CAS  PubMed  Google Scholar 

  31. Fillenbaum GG, Smyer MA (1981) The development, validity and reliability of OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434

    Article  CAS  PubMed  Google Scholar 

  32. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5:165–173

    Article  Google Scholar 

  33. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797–811

    Article  CAS  PubMed  Google Scholar 

  34. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;34:119–126

    Article  CAS  PubMed  Google Scholar 

  35. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383

    Article  CAS  PubMed  Google Scholar 

  36. Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 1994;81:515–526

    Article  Google Scholar 

  37. Van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med 1999;18:681–694

    Article  PubMed  Google Scholar 

  38. Royston P. Multiple imputation of missing values: update. The STATA Journal 2005;5:188–201

    Google Scholar 

  39. Royston P. Multiple imputation of missing values: update of ice. The STATA Journal 2005;5:527–536

    Google Scholar 

  40. Volinsky CT, Raftery AE. Bayesian Information Criterion for Censored Survival Models. Biometrics 2000;56:256–262.

    Article  CAS  PubMed  Google Scholar 

  41. Sleeper LA, Harrington DP. Regression splines in the Cox Model with application to covariate effects in liver disease. J Am Stat Ass 1990;85: 941–949

    Article  Google Scholar 

  42. LeBlanc M, Crowley J. Adaptive Regression Splines in the Cox Model. Biometrics 1999;55: 2004–2013

    Article  Google Scholar 

  43. Liu X. Survival Analysis. Models and Applications. Wiley Higher Education Press p. 236, 2012

    Book  Google Scholar 

  44. Jones DS, Podolsky SH, Greene JA. The burden of diseases and the changing task of medicine. N Eng J Med 2012;366:2333–2338

    Article  CAS  Google Scholar 

  45. Kvamme JM, Holmen J, Wilsgaard T, Florholmen J, Midthjell K, Jacobsen BK. Body mass index and mortality in elderly men and women: the Tromso and HUNT studies. J Epidemiol Community Health 2012;66:611–617

    Article  PubMed Central  PubMed  Google Scholar 

  46. Strandberg TE, Stenholm S, Stranberg AY, Salomaa VV, Pitkala KH, Tilvis RS. The ‘obesity paradox’, frailty, disability, and mortality in older men: a prospective, longitudinal cohort study. Am J Epidemiol 2013;178:1452–1460

    Article  PubMed  Google Scholar 

  47. Gränsbo K, Melander O, Wallentin L, Lindbäck J, Stenestrand U, Carlsson J, Nilsson J. Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. J Am Coll Cardiol 2010;55:1362–1369

    Article  PubMed  Google Scholar 

  48. Tilvis RS, Valvanne JN, Strandberg TE, Miettinen TA. Prognostic significance of serum cholesterol, lathosterol, and sitosterol in old age; a 17-year population study. Ann Med. 2011;43: 292–301

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471, Bialystok, Poland

    Barbara Bień, A. Wojskowicz, A. Kasiukiewicz & Z. B. Wojszel

  2. Institute of Econometrics, Warsaw School of Economics, Warsaw, Poland

    K. Bień-Barkowska

Authors
  1. Barbara Bień
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Bień-Barkowska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Wojskowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kasiukiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Z. B. Wojszel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Bień.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bień, B., Bień-Barkowska, K., Wojskowicz, A. et al. Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people?. J Nutr Health Aging 19, 481–488 (2015). https://doi.org/10.1007/s12603-014-0570-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-014-0570-9

Key words

Search

Navigation