Prognostic factors of elderly patients admitted in a medical intermediate care unit

IntroductionPopulation ageing has determined increased prevalence of chronic illness and functional impairment. Consequently, increased hospital admission of elderly patients is observed, not only in general wards but also in high dependency units such as medical intermediate care units (IntCU), despite uncertainty on their prognostic factors.ObjectiveTo identify prognostic factors of older patients admitted in an IntCU, namely acute illness severity, comorbidity and functional status.DesignProspective observational study.SettingIntCU of a Central and University Hospital.SubjectsOne hundred and seventy-six elderly patients consecutively admitted during 32 months, compared with 112 non-elderly patients.Main outcome measureIntCU mortality and In-hospital mortality.MethodsAt admission acute illness severity, comorbidity and previous functional status were measured. Outcome measurements included IntCU mortality and in-hospital mortality.ResultsComorbidity and functional impairment were higher in elderly. Higher IntCU mortality in elderly patients (13.1%) was also observed as well as a higher in-hospital mortality. SAPS II was the best predictor of both IntCU and in-hospital mortality in elderly group. Charlson index was not a good predictor of IntCU and in-hospital mortality in elderly patients nor Barthel index a protective factor.ConclusionsThis study supports using SAPS II as the standard prognosis assessment tool of elderly admitted in IntCU. Despite Charlson and Barthel indexes were not associated with higher mortality in our study, a comprehensive assessment should be carried out when admitting elderly patients in IntCU, not being age the best criteria. Risk stratification is mandatory to predict benefit of IntCU admission and accurate tools need to be developed.