Variability in Post-Discharge Mortality Rates and Predictors over Time: Data from a Five-Year Ward-Wide Study

Area of Science:

• Gerontology
• Internal Medicine
• Public Health

Background:

• Complex chronic disorders are increasing, leading to frequent hospitalizations.
• Long-term post-discharge mortality and its predictors in these patients are poorly understood.
• This knowledge gap may result in suboptimal care and delayed palliative care referrals.

Purpose of the Study:

• To evaluate the five-year post-discharge mortality rates.
• To identify predictors of mortality in elderly, multi-morbid patients admitted to Internal Medicine.
• To inform patient management and palliative care integration.

Main Methods:

• Analysis of a cohort of elderly, multi-morbid patients admitted to Internal Medicine over 12 months.
• Utilized public health registries to track five-year mortality (up to 2022) for discharged patients.
• Examined clinical factors, frailty, care intensity, and patient complexity as predictors.

Main Results:

• Five-year post-discharge mortality reached 57%, with a 32% one-year peak.
• Cancer, neurological, liver, and respiratory disorders predicted early/intermediate mortality.
• Renal disorders, dependence, and immunodepression predicted first-year mortality.
• Cardiovascular and GI disorders predicted late mortality.
• Frailty and care complexity predicted mortality across all timeframes.

Conclusions:

• A significant proportion of Internal Medicine patients may benefit from palliative care.
• Understanding differential mortality predictors aids patient management.
• Early or simultaneous palliative care identification is crucial for at-risk individuals.