AUTHOR=Lattanzio Fabrizia , Corigliano Valentina , Soraci Luca , Fumagalli Alessia , Onder Graziano , Volpato Stefano , Cherubini Antonio , Ruggiero Carmelinda , Cozza Annalisa , Guarasci Francesco , Corsonello Andrea 

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

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.771115

DOI=10.3389/fmed.2021.771115

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Hospitalized older patients are particularly exposed to adverse health outcomes.</p><p><bold>Objective:</bold> 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.</p><p><bold>Setting and Subjects:</bold> Our series consisted of 503 older patients discharged from acute care hospitals.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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).</p><p><bold>Conclusion:</bold> 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 was</p><p>found to significantly affect survival. Early identification of such high-risk patients may help tailor targeted interventions to counteract their detrimental effects on prognosis.</p>