Characteristics of Centenarians admitted to a Community Teaching Hospital.

ABSTRACT

Background. The "oldest old" are the most rapidly growing segment of society, and clinicians will increasingly encounter this age group in this century.

Methods. To describe the characteristics of a special subgroup of the oldest old, the centenarians, we conducted a retrospective case series analysis of all patients 100 years of age and above admitted to a large community teaching hospital.

Results. Thirty-nine patients with a mean age of 101.3 years were admitted a total of 57 times during the 5-year study period. The main reasons for admission were hip fracture, stroke, and urinary tract infection. Patients admitted from nursing facilities were taking more medications than community dwelling patients, and patients who were confused on admission were more likely to be readmitted. Only 2 patients died.

Conclusions. Polypharmacy is common in centenarians, especially in institutionalized patients, and confusion may be a useful predictor of subsequent readmission. In-hospital however, low in this population.

THE "OLDEST OLD," those aged 85 years or more, are the most rapidly growing segment of American society. (1) Census bureau projections indicate that by the year 2020 there may be 6.7 million Americans more than 85 years of age (2) A special subgroup of the oldest old are the centenarians, patients more than 100 years of age. Since little information exists on the hospitalization of this age group, we sought to determine characteristics of centenarians admitted to our hospital over a 5-year period.

METHODS

We reviewed the medical records of patients aged 100 years and older who were admitted over a 5-year period to Miami Valley Hospital, an 800 bed regional referral facility that is a major teaching affiliate of Wright State University School of Medicine in Dayton, Ohio. Medical records were analyzed for demographic data, including age, sex, number of admissions within the study period, length of stay, and survival. In addition, the number and types of medications were recorded as were the main reasons for hospitalization and the admission service. Inferences were made at an [alpha] level of 0.05.

RESULTS

There were 39 patients with a mean age of 101.3 [+ or -] 1.5 years (range, 100 to 106 years) admitted a total of 57 times. There were 32 women (82%) and 7 men (18%). Most patients (21) were admitted only once during the study period, but 11 patients were admitted twice, 6 patients were admitted three times; and 1 patient was admitted 4 times. The Table shows admission diagnoses. Preadmission residence included home or apartment in 7 patients (18%), nursing facility in 20 (51%), and with are relative in 12 (31%).

A total of 61 scheduled drugs were recorded, with each patient taking a mean of 4.2 [+ or -] 3.2 medications. Patients admitted from a nursing facility were taking more medications than patients residing in the community (5.57 [+ or -] 2.61 vs 2.9 [+ or -] 3.2; P = .007). The most commonly prescribed medications included acetominophen (16 patients), furosemide (12), potassium chloride (8), thyroxine (6), enalapril (6), digoxin (5), aspirin (5), and oral nitrates (5). The admitting service was medical for 29 patients (74%), orthopaedic for 8 patients (21%), and general surgical for 2 patients (5%). Only 1 patient (3%) was admitted to the intensive care unit.

Twenty five patients (64%) had had a recent fall, and 19 (49%) were confused at the time of admission. Patients with a recent fall had a lower serum creatinine value than patients without a recent fall (1.02 +/- 0.23 mg/dL vs 1.43 [+ or -] 0.63 mg/dL; P = .008). Patients confused at initial admission were more likely to be readmitted (P = .003). The mean length of stay was 5.44 +/- 4.8 days; there were two deaths.

DISCUSSION

Centenarians admitted to a large community hospital have a favorable short-term prognosis, with a low risk of in-hospital death. Previous data on the oldest of nonagenarians (95 to 99 years old) also confirm low hospital mortality rates for a variety of admission diagnoses. (3) Approximately half of the patients were community dwelling before admission. This group of patients took fewer medications than patients admitted from nursing facilities. This could be due to more chronic illnesses and poorer overall health among nursing home patients. However, polypharmacy is a problem in all elderly patients, with up to 24% receiving inappropriate medications. (4) A decline in drug clearance mechanisms in elderly patients as well as hypoalbuminemia leading to increased free drug levels (4,5) may increase adverse drug effects, especially in the case of polypharmacy.

We noted an association between lower serum creatinine levels and falls. While this may be coincidence, it is possible that patients with a higher creatinine level may have more muscle mass, which could protect against weakness and falls. Polypharmacy also can lead to falls, (3'4) and we cannot exclude this as a possibility. Since hip fracture was the most common reason for hospitalization, avoiding polypharmacy in frail patients seems prudent. Confusion was associated with hospital readmission and could be due to polypharmacy, dementia, or more serious illness in this patient group; however, we did not specifically address these issues. Prospective studies regarding the acute care of centenarians are needed, since clinicians will increasingly encounter this age group in this century.

From the Department of internal Medicine, Wright State University School of Medicine, Dayton, Ohio. (Dr. Jones is now with the Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.)

Reprint requests to Mark A. Marinella, MD, 33 West Rahn Rd, No. 201, Dayton, OH 45429.

References

(1.) Chelluri L, Pinsky MR, Grenvik ANA: Outcome of intensive care of the "oldest old" critically ill patients. Crit Care Med 1992; 20:757-761

(2.) Schneider EL, Guralnik JM: The aging of America: impact on health care costs. JAMA 1990; 263:2335-2340

(3.) Marinella MA, Jones N, Markert RJ: Acute care of patients aged 95 to 99 years: experience in a community teaching hospital. South Med J 2000; 93:677-680

(4.) Wilcox SM, Himmelstein DU, Woolhandler S: Inappropriate drug prescribing for the community dwelling elderly. JAMA 1994; 272:292-296

(5.) Marinella MA, Markert RJ: Admission serum albumin level and length of hospitalization in elderly patients. South Med J 1998; 91:854-858

TABLE

Initial Admission Diagnoses of 39 Centenarians

Diagnosis                  No. of Patients

Hip fracture                  7 (17.9%)
Stroke                        4 (10.3%)
Urinary tract infection       3 (7.7%)
Vascular ulcer/gangrene       2 (5.1%)
Dehydration                   2 (5.1%)
Cellulitis                    2 (5.1%)
Gastrointestinal bleeding     2 (5.1%)
Syncope                       2 (5.1%)
Bowel obstruction             2 (5.1%)
Chest pain/angina             2 (5.1%)

Each of the following diagnoses occurred in 1 patient: metabolic
acidosis, hematoma, hematuria, incarcerated hernia, pancreatic cancer,
cholecystitis; diveriticulitis, pancreatitis, bronchitis, herpes zoster,
patellar/wrist fracture.

RELATED ARTICLE: KEY POINTS

* The most common reasons for admission among centenarians include hip fracture, stroke, and urinary infection.

* Polypharmacy is more common among patients admitted from nursing facilities than those admitted from the community.

* Centenarians confused on initial admission are more likely to be readmitted.

* Hospital mortality is low in this age group.