49MARKERS OF CLINICAL COMPLEXITY IN HOSPITALISED OLDER PATIENTS WITH PARKINSON’S DISEASE AND ASSOCIATIONS WITH OUTCOMES

Abstract

Background: Older patients with Parkinson's disease (PD) admitted to the acute hospital are often clinically complex, but we do not know whether their clinical characteristics differ to those of non-PD admissions, or if PD is, in the face of routinely measured markers of clinical complexity, an independent predictor of outcomes. Our aim was to address this knowledge gap. Methods: We conducted an observational retrospective case-control study in a tertiary university hospital in England. Routinely measured patient characteristics included demographics, clinical frailty scale (CFS), acute illness severity, Charlson Comorbidity Index (CCI), discharge specialty and presence of delirium, dementia and depression. Outcomes studied were inpatient mortality, death within 30 days of discharge, new institutionalisation, length of stay >7 days and readmission within 30 days. Statistical analyses were based on bivariate comparisons and logistic regression models. Results: Between October 2014 and October 2016, there were 393 first admission episodes of PD patients aged >75 years. 1285 age- and sex-matched controls were randomly selected from 14,777 non-PD episodes. PD patients were: frailer than controls (mean CFS 5.9 vs. 4.8; p < 0.001); more likely to be discharged from a geriatric ward (36.9% vs. 28.1%; p < 0.001); more likely to have dementia (20.9% vs. 11.9%; p < 0.001); more likely to be institutionalised (16.8% vs. 9.9%; p < 0.001). After adjustment for markers of clinical complexity, PD was not an independent predictor of outcomes in the combined sample of cases and controls. On the other hand, CFS was an independent predictor of inpatient mortality (OR 1.8, 95% CI 1.5-2.1; p < 0.001), post-discharge mortality (OR 1.3, 95% CI 1.1-1.6, p = 0.008), new institutionalisation (OR 1.4, 95% CI 1.2-1.5; p < 0.001) and LOS > 7 days (OR 1.2, 95% CI 1.1-1.3; p < 0.001). Conclusions: Our study suggests that the clinical outcomes of older PD patients seemed to be more related to clinical complexity than to PD itself, emphasising the need for holistic rather than disease-centred care.