Five-year survival and prognostic factors in a cohort of hospitalized nonagenarians

BackgroundThe number of hospitalized nonagenarians is increasing. Only a few studies have evaluated long-term predictors of survival in these patients. The aim of this study was to determine the 5-year outcome of a cohort of hospitalized nonagenarians, and to identify predictors of long-term survival.MethodsIn 124 consecutive medical hospitalized patients older than 89 years, and followed up during 5 years, the following variables were prospectively recorded: sociodemographic characteristics, main diagnoses, Charlson comorbidity index, Barthel index, Lawton–Brody test, Mini-Mental State Examination, Short Portable Mental Status Questionnaire of Pfeiffer, Mini Nutritional Assessment, albumin levels, and the 5-year survival.ResultsOut of the 124 patients, 109 died (87.9%) during the follow-up. The probability of being alive at 1, 3 and 5 years was 45%, 22% and 12%, respectively. A worse 5-year survival was significantly related to the diagnoses of pneumonia (p = 0.037), heart failure (p = 0.045), higher Charlson index (p = 0.026), poorer functional status measured by the Barthel index (p = 0.003), and the Lawton–Brody test (p = 0.007), cognitive impairment measured by the Pfeiffer test (p = 0.011), and lower levels of albumin (p = 0.028). In the multivariate analysis, the Charlson index (p < 0.001), and the Barthel index (p = 0.003) were independently related to 5-year survival. These two variables were also 5-year survival prognostic factors in the subgroup of discharged patients. A prognostic index using these two variables was created: PI = (0.2 × Charlson index + 0.6 × Barthel index) × 0.92.ConclusionsIn hospitalized nonagenarian patients, poor scores in the Barthel Index and a higher comorbidity evaluated by the Charlson index are independently related to 5-year survival.