Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study
Background/Purpose: Multimorbidity is a worldwide issue when aging is rapidly. The aim of this study was to evaluate the impact of demography, morbidity, disability and depression on short-term and long-term mortality for multimorbid inpatients. Methods: The participants’ information were assessed u...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-02-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664621002448 |
| _version_ | 1818972599067082752 |
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| author | Chia-Lin Tseng Nin-Chieh Hsu Pei-Iun Hsieh Yu-Feng Lin Ching-Yu Chen Chia-Yi Wu Wang-Huei Sheng |
| author_facet | Chia-Lin Tseng Nin-Chieh Hsu Pei-Iun Hsieh Yu-Feng Lin Ching-Yu Chen Chia-Yi Wu Wang-Huei Sheng |
| author_sort | Chia-Lin Tseng |
| collection | DOAJ |
| description | Background/Purpose: Multimorbidity is a worldwide issue when aging is rapidly. The aim of this study was to evaluate the impact of demography, morbidity, disability and depression on short-term and long-term mortality for multimorbid inpatients. Methods: The participants’ information were assessed upon recruitment. Multimorbidity and disability were measured by modified Charlson comorbidities Index (CCI) and Barthel Index for Activity of Daily Living (ADL), respectively. Depression was screened over one-item self-reported perceptions of depressed mood rated as yes or no. The factors of in-hospital mortality and periodic mortality after discharge were examined by Cox proportional hazard regression and Kaplan–Meier survival analyses. Results: A total of 201 inpatients from a hospitalist's ward were recruited. The in-hospital mortality was 14.4%, while 24-month mortality was 57.8%. After adjustment, severe ADL dependence (<35) was the only contributing factor for in-hospital mortality (Hazard Ratio [HR] = 12.94, p = 0.018). The hazard ratios of 3-6-12-24-months of high CCI (≥6) and severe ADL dependence were 8.12-13.57 (p < 0.001) and 2.91-5.39 (p < 0.001) respectively; both trends of impacts were decreasing overtime. Gender rather than age effect was evident. Besides, self-reported depression was associated with 12-month (HR = 1.72, p = 0.04) and 24-month (HR = 1.65, p = 0.038) mortality. Moreover, severe ADL dependence (p = 0.001) and depression (p = 0.01) contributed to higher mortality in non-cancer patients. Conclusion: Our findings suggested that gender, multimorbidity, and disability influenced the two-year survival, while depression was the strongest factor related to long-term mortality. Clinicians should notice the importance of integrated approach and mental health care for those with severe disabilities and morbidity. |
| first_indexed | 2024-12-20T15:10:49Z |
| format | Article |
| id | doaj.art-a34344aaf98843309740741cf05bbb2f |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-20T15:10:49Z |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-a34344aaf98843309740741cf05bbb2f2022-12-21T19:36:19ZengElsevierJournal of the Formosan Medical Association0929-66462022-02-011212473481Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective studyChia-Lin Tseng0Nin-Chieh Hsu1Pei-Iun Hsieh2Yu-Feng Lin3Ching-Yu Chen4Chia-Yi Wu5Wang-Huei Sheng6Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, TaiwanDivision of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, TaiwanInstitute of Epidemiology and Preventive Medicine, College of Public Health, College of Public Health, National Taiwan University, TaiwanDivision of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, TaiwanDepartment of Family Medicine, National Taiwan University Hospital, TaiwanSchool of Nursing, College of Medicine, National Taiwan University, Taiwan; Department of Nursing, National Taiwan University Hospital, Taiwan; Corresponding author. School of Nursing, National Taiwan University College of Medicine, 1, Jen-Ai Road, Section 1, Taipei, 10051, Taiwan. Fax: +886 2 23935736.Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan. Fax: +886 2 23710615.Background/Purpose: Multimorbidity is a worldwide issue when aging is rapidly. The aim of this study was to evaluate the impact of demography, morbidity, disability and depression on short-term and long-term mortality for multimorbid inpatients. Methods: The participants’ information were assessed upon recruitment. Multimorbidity and disability were measured by modified Charlson comorbidities Index (CCI) and Barthel Index for Activity of Daily Living (ADL), respectively. Depression was screened over one-item self-reported perceptions of depressed mood rated as yes or no. The factors of in-hospital mortality and periodic mortality after discharge were examined by Cox proportional hazard regression and Kaplan–Meier survival analyses. Results: A total of 201 inpatients from a hospitalist's ward were recruited. The in-hospital mortality was 14.4%, while 24-month mortality was 57.8%. After adjustment, severe ADL dependence (<35) was the only contributing factor for in-hospital mortality (Hazard Ratio [HR] = 12.94, p = 0.018). The hazard ratios of 3-6-12-24-months of high CCI (≥6) and severe ADL dependence were 8.12-13.57 (p < 0.001) and 2.91-5.39 (p < 0.001) respectively; both trends of impacts were decreasing overtime. Gender rather than age effect was evident. Besides, self-reported depression was associated with 12-month (HR = 1.72, p = 0.04) and 24-month (HR = 1.65, p = 0.038) mortality. Moreover, severe ADL dependence (p = 0.001) and depression (p = 0.01) contributed to higher mortality in non-cancer patients. Conclusion: Our findings suggested that gender, multimorbidity, and disability influenced the two-year survival, while depression was the strongest factor related to long-term mortality. Clinicians should notice the importance of integrated approach and mental health care for those with severe disabilities and morbidity.http://www.sciencedirect.com/science/article/pii/S0929664621002448MultimorbidityDisabilityDepressionHospitalistMortality |
| spellingShingle | Chia-Lin Tseng Nin-Chieh Hsu Pei-Iun Hsieh Yu-Feng Lin Ching-Yu Chen Chia-Yi Wu Wang-Huei Sheng Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study Journal of the Formosan Medical Association Multimorbidity Disability Depression Hospitalist Mortality |
| title | Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study |
| title_full | Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study |
| title_fullStr | Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study |
| title_full_unstemmed | Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study |
| title_short | Integrated approach for multimorbid patients in a hospitalist setting: Survival analysis of a two-year prospective study |
| title_sort | integrated approach for multimorbid patients in a hospitalist setting survival analysis of a two year prospective study |
| topic | Multimorbidity Disability Depression Hospitalist Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S0929664621002448 |
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