Short-term outcomes of seniors aged 80 years and older with acute illness: hospitalist care by geriatricians and other internists compared

Background: Although acute geriatric units have improved the outcomes of hospitalized seniors, it is uncertain as to whether hospitalist care by geriatricians outside of these units confers similar benefit.

Objective: To determine whether hospitalist care by geriatricians reduces short-term mortality and readmission, and length of stay (LOS) for seniors aged 80 years and older with acute medical illnesses compared with care by other internists.

Design: Retrospective cohort study using administrative and chart review data on demographic, admission-related, and clinical information of hospital episodes.

Setting: General internal medicine department of an acute-care hospital in Singapore from 2005 to 2008.

Patients: Seniors aged 80 years and older with specific focus on 2 subgroups with premorbid functional impairment and acute geriatric syndromes.

Intervention: Hospitalist care by geriatricians compared with care by other internists.

Measures: Hospital mortality, 30-day mortality or readmission, and LOS.

Results: For 1944 hospital episodes (intervention: 968, control: 976), there was a nonsignificant trend toward lower hospital mortality (15.5% vs 16.9%) but not 30-day mortality or readmission, or LOS for care by geriatricians compared with care by other internists. A marginally stronger trend toward lower hospital mortality for care by geriatricians among those with acute geriatric syndromes (20.2% vs 23.1%) was observed. Similar treatment effects were found after adjustment for demographic, admission-related, and clinical factors.

Conclusions: For seniors aged 80 years and over with acute medical illness, hospitalist care by geriatricians did not significantly reduce short-term mortality, readmission, or LOS, compared with care by other internists.