Facteurs prédictifs de mortalité dans un service de court séjour gériatrique

Abstract : Introduction: The French population is aging, leading to an increase in the number of hospitalizations for patients aged 75 and over. The mortality of elderly patients in hospitalization is greater than in the young, and the deaths are due to the decompensation of chronic pathologies caused by an acute event. In geriatric care, Acute Care Geriatric Unit provide care for a heterogeneous, polypathological and at-risk elderly population. The objective of our study was to determine the predictive factors of mortality during hospitalization and at one month of discharge in patients aged 75 and over hospitalized in an Acute Care Geriatric Unit.
Materials and methods: A cohort study, observational, retrospective, was conducted in an Acute Care Geriatric Unit of the RAV pole of the University Hospital Center of Nice from November 1, 2016 to April 30, 2017. Included patients were aged 75 and over. For each patient, sociodemographic data, their co-morbidities, standardized geriatric evaluation data, medications as well as biological data were collected and analyzed according to the status of "alive" or "deceased" during hospitalization and then at one month of their discharge from hospital.
Results: A total of 587 patients had been included with an average age of 87.1 ± 5.7 years. 65.4% were women, 83.0% came from home, with an average Charlson score of 7.5. Mortality during hospitalization was 13.3% and mortality at one month of discharge from hospital was 22.96%. In multivariate analysis, predictive factors of mortality were confusion, benzodiazepine use and living in EHPAD for mortality during hospitalization and at one month as well as pressure ulcers, a biological inflammatory syndrome, and antibiotics for mortality at one month only.
Conclusion: Confusion is the main predictor of mortality during hospitalization in an Acute Care Geriatric Unit but also one month after discharge. The confusion must be systematically detected and its management must be based on the recommendations of the HAS. Benzodiazepine treatment is the second potentially reversible risk factor, so their prescriptions should be kept to a minimum, and the treatment re-evaluated with, if possible, progressive stops to avoid withdrawal syndromes. Finally, residents of EHPAD are at higher risk of mortality during hospitalization. In our study, three additional factors are predictive of mortality at one month of hospital discharge, the presence of pressure ulcers, the prescription of antibiotic therapy and the demonstration of a biological inflammatory syndrome.
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Master Thesis
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François Rousseau. Facteurs prédictifs de mortalité dans un service de court séjour gériatrique. Médecine humaine et pathologie. 2018. ⟨dumas-01976163⟩

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