Data from a prospective observational cohort in a geriatric ward at a university hospital were analyzed. The study protocol was approved by the Ethics Committee of Nagoya University Graduate School of Medicine (approval no. 2019-0260) and conducted in accordance with the principles of the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants. In the case that participants were unable to provide consent, family members provided informed consent on their behalf.
1. Eligibility criteria
Patients aged ≥65 years who were admitted to the geriatric ward of Nagoya University Hospital were recruited between October 2019 and September 2021. The following exclusion criteria were applied: discharge from hospital within 48 h; inability to secure written informed consent; estimated life expectancy less than 1 month at the time of admission in the opinion of the attending physician; readmission within 3 months after discharge and enrolled in the study at the time of the previous admission; transfer from another hospital department; and any other reason deemed to preclude participation; and any other reason deemed to preclude participation by the investigators.
2. Data collection
Data were collected at the time of admission (within the first 48 h) and HACs during the hospitalization period were recorded. The attending physicians obtained information on the occurrence of falls, readmission to any hospital, emergency room (ER) visits, and death by telephone interviews with each patient or caregiver who provided informed consent at 3 months after discharge.
2.1 At admission
Demographic data, including age and sex, were obtained from the clinical records. A comprehensive battery of geriatric assessments was performed in each case by the attending physician. The assessments included the Charlson Comorbidity Index (CCI) score [11], Clinical Frailty Scale (CFS) score [12], and Mini-Nutritional Assessment-Short Form (MNA-SF) score for nutrition [13]. Functional status was assessed using the Barthel Index (BI) [14] at baseline (2 weeks before admission).
2.2 Geriatric conditions
GCs were defined as symptoms of pain, mood disturbance, anxiety, incontinence, dizziness, constipation, impairment of vision or hearing, and malnutrition. They were assessed by the attending physician at the time of admission. Malnutrition was defined as an MNA-SF score below 7.
2.3 Hospital-acquired complications
HACs were defined as the occurrence of delirium, functional decline, incontinence, fall, pressure injury, or nosocomial infection during hospitalization [10]. Delirium was evaluated daily by the attending physician based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Functional decline was defined as a BI score at discharge that was lower than that at admission (2 weeks before admission. Incontinence was included if described as newly recognized in the medical records. Falls were also evaluated from the medical records, as were newly recognized pressure injuries. Nosocomial infections were evaluated by the attending physician.
2.4 Consequences after discharge
The attending physicians collected information on falls, readmission, ER visits, and death within 3 months of discharge from hospital by telephone interviews with patients or their caregivers.
3. Statistical analysis
Multiple regression analysis was performed to explore the association of the number of GCs with CFS score or the number of prescribed medications at admission with adjustment for age, sex, and CCI score. The association of GC with the occurrence of HACs was investigated by multiple logistic regression analysis with adjustment for age, sex, CFS score, CCI score, and number of medications. The association of GCs with fall, re-admission/ER visit, and mortality was evaluated by multiple logistic regression analysis. Data are shown as the mean and standard deviation or as the number and/or percentage as appropriate.