Factors associated with in-hospital mortality in octogenarians managed by geriatric service in a referral hospital in Colombia
Abstract
Introduction: The demographic transition has significantly increased the number of hospitalizations in octogenarian patients. Previous studies have documented the importance of clinical, functional, and cognitive variables for in-hospital mortality risk, but their frequency and importance in Latin American populations is yet to be described. It is important because Colombia has multiple ethnic races, with different types of longevity, and we have a history of social violence that affects our life expectancy. The aim of this study is to define which risk factors are associated with in-hospital mortality in octogenarians, and how frequent they are and quantify the weight of each of these factors in the outcomes.
Methodology: We present an analytical observational retrospective cohort study in adult patients over 80 years of age hospitalized and followed by the geriatrics service at Hospital Universitario San Ignacio (Bogotá, Colombia). The association between in-hospital mortality and multiple clinical, functional, and cognitive variables was evaluated by means of univariate and multivariate logistic regression analysis.
Results: A total of 1235 hospitalizations were analyzed (age 85.5 ± 4.4 years, 58.62% women). Malnutrition was documented in 22.4%, dependency for basic activities (Barthel ⩽ 95) in 75.9%, and positive screening for frailty (FRAIL ⩾ 3) in 55.3%. Mortality was 5.67%. Factors independently associated with mortality were history of cancer (Odds ratio (OR): 2.31; 95% Confidence interval (CI): 1.34-3.98, p < 0.003), delirium (OR: 2.48; 95% CI: 1.44-4.28, p < 0.001), malnutrition (OR: 2.50; 95% CI: 1.46-4.28; p = 0.001), frailty (OR: 2.25; 95% CI: 1.13-4.45, p = 0.019), tachypnea on admission (OR: 1.09; 95% CI: 1.03-1.14, p = 0.002), and creatinine elevation (OR: 2.47; 95% CI: 1.47-4.15, p = 0.001).
Conclusion: Factors easily identifiable at hospital admission and amenable to intervention could predict an increased risk of mortality in octogenarian patients, such as the presence of malnutrition, frailty, and delirium. These findings facilitate the estimation of mortality risk and serve as a starting point to investigate the potential benefit of early interventions in this population.
Keywords: delirium; frailty; hospital mortality; malnutrition; older adults.
© The Author(s) 2025.
References
DANE. Quality of Life Survey. Older people in Colombia, towards inclusion and participation [Internet]. XV International Congress on Aging and Old Age: Decade of Healthy Aging 2020–2030; 2021.
Arrieta Romero MA, Lara MA, Rojas KG. Older persons in Colombia: towards inclusion and participation. Dane information for all, 2022.
Otero A. Departmental differences in the causes of mortality in Colombia. Banco de la república, centro de estudios economicosregionales, 2013.
Lama Valdivia J, Cedillo-Ramirez L, Soto A. Factors associated with mortality in hospitalized older adults in an internal medicine service. Rev Peru Med Exp Public Health 2021; 38(2): 284–290. – PubMed
Roson M, Benchimol J, Rodota L, et al.. Effect of nutritional status on mortality and functional recovery in older adults with hip fracture. Acta Ortop Mex 2021; 34(2): 96–102. – PubMed
Martínez-Reig M, Flores Ruano T, Fernández Sánchez M, et al.. Frailty as a predictor of mortality, incident disability and long-term hospitalization in Spanish elderly FRADEA study. Rev Esp Geriatría Gerontol 2016; 51(5): 254–259. – PubMed
Lozano Keymolen D, Montoya Arce BJ, Gaxiola Robles, Linares SC, et al.. Functional dependence and its relationship with overall mortality in older adults. Mexico: 2001–2015. Poblac Salud En Mesoamérica 2017; 15(2): 38–68.
Tamayo Giraldo FJ, Baracaldo Pinzón LI, Valencia Almonacid SL, et al.. Active aging index in Colombia: analysis based on the National Survey of Health, Well-being and Aging (SABE Colombia 2015). Rev Panam Public Health 2021; 45: e69. – PMC – PubMed
Teresa Vidán Astiz M, Sánchez García E, Alonso Armesto M, et al.. Functional deterioration during hospitalization in the elderly. Benefits of admission to the geriatrics service. Rev Esp Geriatría Gerontol 2008; 43(3): 133–138. – PubMed
Verhave JC, Fesler P, Ribstein J, et al.. Estimation of renal function by serum creatinine and predictive formulas in Cuban lithiasic population. Rev Cuba Med 2014; 53(3): 254–265.
Chronic Kidney Disease Prognosis Consortium; Matsushita K, van der Velde M, et al.. Association of estimated glomerular filtration rate and albuminuria with all- cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375(9731): 2073–2081. – PMC – PubMed
World Health Organization (WHO). Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: WHO, 2024. – PubMed
Curcio C, Gomez F, Osorio J. Recurrent falls in the elderly. Acta Medica Colomb 2019; 34(3): 103–110.
Chavarro-Carvajal DA, Heredia R, Venegas LC. Frequently used scales in geriatrics [Internet]. 2a edition. Bogotá, Colombia; 2020, pp. 27–28.
Chavarro-Carvajal DA, Heredia R, Venegas LC. Frequently used scales ingeriatrics [Internet]. 2a edition. Bogotá, Colombia, 2020, pp. 49–60.
IBM. Friedman test. IBM, 2024.
Cortés-Sierra D, Forero-Durán NJ, Sarmiento-Reyes ÉM, et al.. Mortality in patients hospitalized in the internal medicine service of a University Hospital in Bogotá. Acta Méd Colomb 2019; 44(1): 11–16.
World Health Organization. Top 10 causes of death. Geneva: World Health Organization, 2020.
Silva TJ, Jerussalmy CS, Farfel JM, et al.. Predictors of in-hospital mortality among older patients. Clinics (Sao Paulo) 2009; 64(7): 613–618. – PMC – PubMed
Tufan A, Tolu T, Senturk Durmus N, et al.. FRAIL Scale: an independent predictor of in-hospital mortality among older adults. Eur Rev Med Pharmacol Sci 2023; 27(21): 10396–10402. – PubMed
Acosta-Benito MÁ, Martín-LesendeI. Frailty in primary care: diagnosis and multidisciplinary management. Aten Prim 2022; 54(9): 102395. – PMC – PubMed
Kojima G, Iliffe S, Walters K. Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing 2018; 47(2): 193–200. – PubMed
Rodríguez MG, Sichacá EG. Mortality due to malnutrition in the elderly, Colombia, 2014–2016. Biomédica 2019; 39(4): 663–672. – PMC – PubMed
Espinosa EH, Abril-Ulloa V, Encalada TL. Prevalence of malnutrition and associated factors in olderin the canton of Gualaceo, Ecuador. Rev Chil Nutr 2019; 46(6): 675–682.
Carrasco M, Zalaquett M. Delirium: an epidemic from the emergency department to the critical patient unit. Rev Méd Clín Las Condes 2017; 28(2): 301–310.
Siddiqi N, Harrison JK, Clegg A, et al.. Interventions for preventing delirium in hospitalized non-ICU patients. Cochrane Database Syst Rev 2016; 3(3): CD005563. – PMC – PubMed
López Pardo P, Socorro García A, Baztán Cortés JJ. Influence of length of hospital stay on mortality after discharge in elderly patients with acute medical pathology. Gac Sanit 2016; 30(5): 375–378. – PubMed
Herrera Viloche M. Prolonged hospital stay associated with mortality in Hospital Regional Docente de Trujillo, 2014. Rev ECIPeru 2018; 63–67.
Tal S. Length of hospital stay among oldest-old patients in acute geriatric ward. Arch Gerontol Geriatr 2021; 94: 104352. – PubMed
Gutiérrez Oliet M, León Sanz M. GLIM (GlobalLeadership Initiative on Malnutrition) criteria: development, validation and application in clinical practice. Nutr Clin En Med 2022; XVI(3): 195–207.