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3. Prognostic stratification of older persons based on simple administrative data: development and validation of the 'Silver Code,' to be used in emergency department triage

Author

Di Bari, Mauro, Balzi, Daniela, Roberts, Anna T., Barchielli, Alessandro, Fumagalli, Stefano, Ungar, Andrea, Bandinelli, Stefania, De Alfieri, Walter, Gabbani, Luciano, and Marchionni, Niccolo

Subjects
Aged patients -- Care and treatment, Geriatrics -- Access control, Codes -- Usage, Health, Seniors
Abstract

Background. Prognostic stratification of older patients with complex medical problems among those who access the emergency department (ED) may improve the effectiveness of geriatric interventions. Whether such targeting can be performed through simple administrative data is unknown. Methods. We examined the discharge records for 10,913 patients aged 75 years or older admitted during 2005 to the ED of all public hospitals in Florence, Italy. Using information on demographics, drug treatment, previous hospital admissions, and discharge diagnoses, we developed a 1 -year mortality prognostic index. The predictive validity of this index was tested in a subsample of patients independent of the subsample used for its original development. Finally, we tested whether patients stratified by the prognostic index had different mortality when admitted to a geriatrics compared with an internal medicine ward. Results. In the validation subsample, patients with scores of 4-6, 7-10, and 11+ compared with those with scores less than 4 had hazard ratios (95% confidence interval) for 1-year mortality of, respectively, 1.5 (1.3-1.7), 2.2 (1.3-1.7), and 3.0 (2.6-3.4). Patients in the worse prognostic stratum experienced 33% higher mortality when admitted to an internal medicine compared with a geriatrics ward, although mortality was not significantly affected by the type of ward of admission in all other risk strata. Conclusions. Simple administrative data provide prognostic information on long-term mortality in older patients hospitalized via ED. Patients with worse prognostic index scores appear to benefit from admission in a geriatrics compared with an internal medicine ward. Key Words: Elderly persons--Emergency department--Administrative data--Prognosis--Silver Code. doi: 10.1093/gerona/glp043

Published
2010

15. THROUGH THE LOOKING GLASS AND WHAT FRAILTY FOUND THERE: LOOKING FOR RESILIENCE IN OLDER ADULTS

Author

De Alfieri, Walter and Borgogni, Tiziano

Subjects
Aged, Health, Seniors
Abstract

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2010.02754.x Byline: Walter De Alfieri (*), Tiziano Borgogni (*) Author Affiliation: (*)Department of Frail Elderly and Chronicity, Geriatric Unit, Azienda Sanitaria di Grosseto, Grosseto, Italy

Published
2010

23. Spending On Health Care Close To Death.

Author

Nisticò, Francesca, De Alfieri, Walter, and Piacentini, Paolo

Subjects
*MEDICAL care costs, *TERMINAL care, *COST analysis
Abstract

A letter to the editor is presented in response to the article "Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions," by Matthew Davis et al. in the July 2016 issue.

Published
2016
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