Predictors of two-year mortality in older nursing home residents. The IRA study. Istituto di Riposo per Anziani.

Besides functional impairment, several factors have been associated with mortality in institutionalized older subjects, including advanced age, gender, comorbidity, and malnutrition. We investigated the possible association of a large number of factors, including functional, anthropometric, nutritional, metabolic, clinical, and demographic variables, with two-year all-cause mortality in a sample of 344 institutionalized older subjects (> or = 65 years) without evidence of acute illness at the time of observation. Although a number of factors were associated with mortality risk, multivariate analysis showed that only severe disability (6 vs 0-1 lost ADL, O.R.: 3.37, C.I. 95%: 1.76-7.3) and low albumin levels (lowest vs highest tertile: O.R.: 3.0, C.I. 95%: 1.65-5.43) were independent predictors of outcome. Moreover, in the analysis stratified for degree of disability and albumin tertiles, we found a strong gradient in mortality risk with increasing disability and decreasing albumin levels. These results further support the value of these two simple parameters in identifying frail institutionalized older individuals.