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Mortality after chronic subdural hematoma is associated with frailty
Jurre Blaauw1,2, Bram Jacobs3, Heleen M den Hertog4
1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.blaauw02@umcg.nl.
Insights
Patients with chronic subdural hematoma (CSDH) face higher mortality rates than the general population. Frailty indicators like falls and inability to live independently significantly increase mortality risk in CSDH patients.
Area of Science:
- Neurology
- Geriatrics
- Epidemiology
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurological condition, particularly in elderly individuals.
- While increased long-term mortality in CSDH patients is suspected, the underlying causes remain unclear.
- This study investigates the relationship between frailty and mortality in CSDH patients.
Purpose of the Study:
- To determine mortality rates and causes of death in CSDH patients compared to the general population.
- To assess the association between specific frailty indicators and mortality risk in CSDH patients.
Main Methods:
- A cohort study design comparing 1307 CSDH patients with the general population.
- Analysis of mortality rates and causes of death.
- Assessment of six frailty indicators: cognitive issues, falls, independence, self-care ability, psychotropic medication use, and medication count.
Main Results:
- CSDH patients exhibited a 34% higher mortality hazard ratio (HR 1.34) compared to controls.
- Higher mortality was observed in CSDH patients due to cardiovascular diseases and falls.
- Independent predictors of mortality in CSDH patients included frequent falling (HR 1.3), inability to live independently (HR 1.4), and inability to perform daily self-care (HR 1.5).
Conclusions:
- CSDH patients experience elevated mortality rates compared to the general population.
- Frailty is significantly associated with increased mortality risk among CSDH patients.
- Clinical attention to frailty assessment and management in CSDH patients is crucial.
Purpose:
Chronic subdural hematoma (CSDH) is a common neurological disease often affecting the elderly. Long-term excess mortality for patients after CSDH has been suggested but causes of death are unknown. We hypothesize that excess mortality of CSDH patients is related to frailty. In this article, we describe mortality rates and causes of death of CSDH patients compared with the general population and assess the association of frailty with mortality.
Methods:
A cohort study in which consecutive CSDH patients were compared to the general population regarding mortality rates. Furthermore, the association of six frailty indicators (cognitive problems, frequent falling, unable to live independently, unable to perform daily self-care, use of benzodiazepines or psychotropic drugs, and number of medications) with mortality was assessed.
Results:
A total of 1307 CSDH patients were included, with a mean age of 73.7 (SD ± 11.4) years and 958 (73%) were male. Median follow-up was 56 months (range: 0-213). Compared with controls CSDH patients had a hazard ratio for mortality of 1.34 (95% CI: 1.2-1.5). CSDH patients more often died from cardiovascular diseases (37% vs. 30%) and falls (7.2% vs. 3.7%). Among CSDH patients frequent falling (HR 1.3; 95% CI: 1.0-1.7), inability to live independently (HR 1.4, 95% CI: 1.1-1.8), inability to perform daily self-care (HR 1.5; 95% CI: 1.1-1.9), and number of medications used (HR 1.0; 95% CI: 1.0-1.1) were independently associated with mortality.
Conclusions:
CSDH patients have higher mortality rates than the general population. Frailty in CSDH patients is associated with higher mortality risk. More attention for the frailty of CSDH patients is warranted.
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