Introduction: The clinical problems and needs of our oldest olds (> = 85yrs) are often substantially different from those of younger patients, including younger elderly patients (age 65-84 years). Identifying differences in prognostic indicators and outcomes between oldest old and younger nursing home (NH) residents may inform appropriate clinical decision making.
Methods: We retrospectively analysed data from consecutive admissions from NHs to an Acute Medical Assessment Unit between January 2005 and December 2007. Admission clinical and laboratory measures and in-patient mortality, length of hospital stay and patient survival outcomes until March 2009 were compared between younger (<85) and older (> = 85) groups using multiple regression methods.
Results: 316 patients (mean 84.3, SD 8.34 years) were included (68% females). Admission characteristics were similar between age groups. Significantly more male patients in the oldest old group died in hospital compared to those in the younger category (OR 2.92; 1.05-8.12). For those who died during admission the younger group had almost double the average length of stay compared to their older counterparts. Hazards (HR) of dying in oldest olds after the admission and after discharge compared to the younger group were 1.43(1.09-1.89) and 1.37(1.05-1.81), respectively. Mortality at thirty, sixty and ninety days remains exceptionally high;. 32% of <85 and 38% of > = 85 year olds admitted from NHs were deceased at thirty days post admission. At ninety days, 50% of oldest olds and 42% of <85s had died. Out of all NH admissions to hospital, 41 patients <85 years (26%) were readmitted in comparison to only 26 (16%) among the oldest old (p = 0.05).
Conclusion: Whilst the admission characteristics are similar between younger and older patients from NHs, there is evidence to suggest worse long-term survival prospects for oldest old patients. Further studies should focus on development and testing of management strategies to provide longer term appropriate care in this patient population.