Older women are frailer, but less often die then men: a prospective study of older hospitalized people.
Cohort study
Hospital
Multidimensional Prognostic Index
Prognosis
Sex
Journal
Maturitas
ISSN: 1873-4111
Titre abrégé: Maturitas
Pays: Ireland
ID NLM: 7807333
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
20
03
2019
revised:
17
06
2019
accepted:
30
07
2019
entrez:
29
9
2019
pubmed:
29
9
2019
medline:
27
12
2019
Statut:
ppublish
Résumé
The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge. Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.
Identifiants
pubmed: 31561828
pii: S0378-5122(19)30183-5
doi: 10.1016/j.maturitas.2019.07.025
pmc: PMC7461698
mid: NIHMS1620556
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
81-86Subventions
Organisme : Intramural NIH HHS
ID : Z99 AG999999
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
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