Jurre Blaauw1,2, Bram Jacobs3, Heleen M den Hertog4, Niels A van der Gaag5, Korné Jellema6, Ruben Dammers7, Kuan H Kho8,9, Rob J M Groen10, Joukje van der Naalt3, Hester F Lingsma11. 1. Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.blaauw02@umcg.nl. 2. Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. j.blaauw02@umcg.nl. 3. Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands. 5. University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haaglanden Medical Center & Haga Teaching Hospital, Leiden & The Hague, The Netherlands. 6. Department of Neurology, Haaglanden Medical Centre, The Hague, The Netherlands. 7. Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, The Netherlands. 8. Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands. 9. Clinical Neurophysiology Group, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands. 10. Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands. 11. Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Abstract
PURPOSE: Chronic subdural hematoma (CSDH) is a common neurological disease often affecting the elderly. Long-term excess mortality for patients after CSDH has been suggested but causes of death are unknown. We hypothesize that excess mortality of CSDH patients is related to frailty. In this article, we describe mortality rates and causes of death of CSDH patients compared with the general population and assess the association of frailty with mortality. METHODS: A cohort study in which consecutive CSDH patients were compared to the general population regarding mortality rates. Furthermore, the association of six frailty indicators (cognitive problems, frequent falling, unable to live independently, unable to perform daily self-care, use of benzodiazepines or psychotropic drugs, and number of medications) with mortality was assessed. RESULTS: A total of 1307 CSDH patients were included, with a mean age of 73.7 (SD ± 11.4) years and 958 (73%) were male. Median follow-up was 56 months (range: 0-213). Compared with controls CSDH patients had a hazard ratio for mortality of 1.34 (95% CI: 1.2-1.5). CSDH patients more often died from cardiovascular diseases (37% vs. 30%) and falls (7.2% vs. 3.7%). Among CSDH patients frequent falling (HR 1.3; 95% CI: 1.0-1.7), inability to live independently (HR 1.4, 95% CI: 1.1-1.8), inability to perform daily self-care (HR 1.5; 95% CI: 1.1-1.9), and number of medications used (HR 1.0; 95% CI: 1.0-1.1) were independently associated with mortality. CONCLUSIONS: CSDH patients have higher mortality rates than the general population. Frailty in CSDH patients is associated with higher mortality risk. More attention for the frailty of CSDH patients is warranted.
PURPOSE: Chronic subdural hematoma (CSDH) is a common neurological disease often affecting the elderly. Long-term excess mortality for patients after CSDH has been suggested but causes of death are unknown. We hypothesize that excess mortality of CSDH patients is related to frailty. In this article, we describe mortality rates and causes of death of CSDH patients compared with the general population and assess the association of frailty with mortality. METHODS: A cohort study in which consecutive CSDH patients were compared to the general population regarding mortality rates. Furthermore, the association of six frailty indicators (cognitive problems, frequent falling, unable to live independently, unable to perform daily self-care, use of benzodiazepines or psychotropic drugs, and number of medications) with mortality was assessed. RESULTS: A total of 1307 CSDH patients were included, with a mean age of 73.7 (SD ± 11.4) years and 958 (73%) were male. Median follow-up was 56 months (range: 0-213). Compared with controls CSDH patients had a hazard ratio for mortality of 1.34 (95% CI: 1.2-1.5). CSDH patients more often died from cardiovascular diseases (37% vs. 30%) and falls (7.2% vs. 3.7%). Among CSDH patients frequent falling (HR 1.3; 95% CI: 1.0-1.7), inability to live independently (HR 1.4, 95% CI: 1.1-1.8), inability to perform daily self-care (HR 1.5; 95% CI: 1.1-1.9), and number of medications used (HR 1.0; 95% CI: 1.0-1.1) were independently associated with mortality. CONCLUSIONS: CSDH patients have higher mortality rates than the general population. Frailty in CSDH patients is associated with higher mortality risk. More attention for the frailty of CSDH patients is warranted.
Authors: Elsa Dent; Finbarr C Martin; Howard Bergman; Jean Woo; Roman Romero-Ortuno; Jeremy D Walston Journal: Lancet Date: 2019-10-12 Impact factor: 79.321
Authors: Nicholas R Evans; Jasmine Wall; Benjaman To; Stephen J Wallis; Roman Romero-Ortuno; Elizabeth A Warburton Journal: Age Ageing Date: 2020-07-01 Impact factor: 10.668