Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients

Background: Hospitalized older patients are particularly exposed to adverse health outcomes.Objective: In this study, we aimed at investigating the prognostic interactions between disability in basic activities of daily living (BADL), cognitive impairment, low handgrip strength, anticholinergic cogn...

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Autores principales:	Fabrizia Lattanzio, Valentina Corigliano, Luca Soraci, Alessia Fumagalli, Graziano Onder, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Annalisa Cozza, Francesco Guarasci, Andrea Corsonello
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	hospitalized older patients anticholinergic burden functional impairment cognitive impairment handgrip depression Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b434bc810c194de1a5e1d64779aff24c
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spelling	oai:doaj.org-article:b434bc810c194de1a5e1d64779aff24c2021-12-01T01:14:02ZUnveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients2296-858X10.3389/fmed.2021.771115https://doaj.org/article/b434bc810c194de1a5e1d64779aff24c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.771115/fullhttps://doaj.org/toc/2296-858XBackground: Hospitalized older patients are particularly exposed to adverse health outcomes.Objective: In this study, we aimed at investigating the prognostic interactions between disability in basic activities of daily living (BADL), cognitive impairment, low handgrip strength, anticholinergic cognitive burden (ACB), and depression on 1-year mortality.Setting and Subjects: Our series consisted of 503 older patients discharged from acute care hospitals.Methods: Disability in at least one BADL, ACB, depression, cognitive impairment, and low handgrip strength was considered in the analysis. One-year mortality was investigated by Cox regression analysis and prognostic interactions among study variables were assessed by survival tree analysis.Results: Basic activities of daily living disability, ACB, cognitive impairment, and low handgrip strength were significantly associated with 1-year mortality. Survival tree analysis showed that patients with BADL disability and high ACB carried the highest risk of poor survival [hazard ratio (HR): 16.48 (2.63–74.72)], followed by patients with BADL disability and low ACB (HR: 8.43, 95% CI: 1.85–38.87). Patients with cognitive impairment and no BADL disability were characterized by a lower but still significant risk of mortality (HR: 6.61, 95% CI: 1.51–28.97) and those with high ACB scores and good cognitive and functional performance (HR: 5.28, 95% CI: 1.13–24.55).Conclusion: Basic activities of daily living dependency, cognitive impairment, and ACB score were the three main predictors of 1-year mortality among patients discharged from acute care hospitals; the interaction between BADL dependency and ACB score wasfound to significantly affect survival. Early identification of such high-risk patients may help tailor targeted interventions to counteract their detrimental effects on prognosis.Fabrizia LattanzioValentina CoriglianoLuca SoraciAlessia FumagalliGraziano OnderStefano VolpatoStefano VolpatoAntonio CherubiniCarmelinda RuggieroAnnalisa CozzaFrancesco GuarasciAndrea CorsonelloAndrea CorsonelloFrontiers Media S.A.articlehospitalized older patientsanticholinergic burdenfunctional impairmentcognitive impairmenthandgripdepressionMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hospitalized older patients anticholinergic burden functional impairment cognitive impairment handgrip depression Medicine (General) R5-920
spellingShingle	hospitalized older patients anticholinergic burden functional impairment cognitive impairment handgrip depression Medicine (General) R5-920 Fabrizia Lattanzio Valentina Corigliano Luca Soraci Alessia Fumagalli Graziano Onder Stefano Volpato Stefano Volpato Antonio Cherubini Carmelinda Ruggiero Annalisa Cozza Francesco Guarasci Andrea Corsonello Andrea Corsonello Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
description	Background: Hospitalized older patients are particularly exposed to adverse health outcomes.Objective: In this study, we aimed at investigating the prognostic interactions between disability in basic activities of daily living (BADL), cognitive impairment, low handgrip strength, anticholinergic cognitive burden (ACB), and depression on 1-year mortality.Setting and Subjects: Our series consisted of 503 older patients discharged from acute care hospitals.Methods: Disability in at least one BADL, ACB, depression, cognitive impairment, and low handgrip strength was considered in the analysis. One-year mortality was investigated by Cox regression analysis and prognostic interactions among study variables were assessed by survival tree analysis.Results: Basic activities of daily living disability, ACB, cognitive impairment, and low handgrip strength were significantly associated with 1-year mortality. Survival tree analysis showed that patients with BADL disability and high ACB carried the highest risk of poor survival [hazard ratio (HR): 16.48 (2.63–74.72)], followed by patients with BADL disability and low ACB (HR: 8.43, 95% CI: 1.85–38.87). Patients with cognitive impairment and no BADL disability were characterized by a lower but still significant risk of mortality (HR: 6.61, 95% CI: 1.51–28.97) and those with high ACB scores and good cognitive and functional performance (HR: 5.28, 95% CI: 1.13–24.55).Conclusion: Basic activities of daily living dependency, cognitive impairment, and ACB score were the three main predictors of 1-year mortality among patients discharged from acute care hospitals; the interaction between BADL dependency and ACB score wasfound to significantly affect survival. Early identification of such high-risk patients may help tailor targeted interventions to counteract their detrimental effects on prognosis.
format	article
author	Fabrizia Lattanzio Valentina Corigliano Luca Soraci Alessia Fumagalli Graziano Onder Stefano Volpato Stefano Volpato Antonio Cherubini Carmelinda Ruggiero Annalisa Cozza Francesco Guarasci Andrea Corsonello Andrea Corsonello
author_facet	Fabrizia Lattanzio Valentina Corigliano Luca Soraci Alessia Fumagalli Graziano Onder Stefano Volpato Stefano Volpato Antonio Cherubini Carmelinda Ruggiero Annalisa Cozza Francesco Guarasci Andrea Corsonello Andrea Corsonello
author_sort	Fabrizia Lattanzio
title	Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
title_short	Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
title_full	Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
title_fullStr	Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
title_full_unstemmed	Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients
title_sort	unveiling the burden of interactions among clinical risk factors for 1-year mortality in hospitalized older patients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/b434bc810c194de1a5e1d64779aff24c
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Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients

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