Mortality Predictors of Patients Receiving Care in a Geriatric Home Care Unit, During a Six Months Follow-up After the Intervention

Abstract

Purpose: To describe the characteristics of patients attended by a Home Geriatric Care Unit (HGCU) and the predictors of mortality during the intervention and after 6 months of follow-up. Methods: This prospective observational study included patients attended by the HGCU of the Hospital Universitario Central de la Cruz Roja (from June 1 to December 31, 2021) with a 6-month follow-up. Sociodemographic, clinical, functional, and cognitive variables were recorded, together with the waiting times until the first visit, length of stay, number of new diagnoses, additional tests, origin, and the number of medical and nursing visits. Mortality and its predictors were assessed. Descriptive and multivariate analyses were performed, along with Kaplan-Meier curves (95%CI; p<0.05). Results: 241 patients were included (89.4±6.1 years; 72.6% women). There was high co-morbidity (38.9% Charlson Index≥3), frailty (Clinical Frailty Scale-CFS≥5: 97.9%), polypharmacy (average number of medications was 12.1±4.6), Barthel Index (BI) mean 39.9±27.3, with 60.1% having dementia and 70.1% Nutritional risk (CONtrolling NUTritional Status-CONUT>1). Anemia was found in 43% and renal function impairment (glomerular filtration rate <60 ml/min/m²) in 90.4%. The average length of participation in the program was 17.4±17.9 days, with 2.9±2.7 medical visits and 2.7±2.7 nursing visits. New diagnoses were established in 83.8% of patients. Mortality was 5.4% (13 patients) during the intervention and 22.8% at 6 month. Predictive variables of mortality in multivariate analysis included worse functional and cognitive status at discharge, poorer nutritional status and renal function, higher number of medical and nursing visits, and new diagnoses establishment. Conclusion: The HGCU program cares for older patients with high co-morbidity and care needs, complementing the role of Primary Care. Factors such as functional, cognitive and nutritional status, renal function, and the number of medical and nursing visits are predictors of mortality at 6 months.