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Background The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization. Methods A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period. Results Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR = 1.83; 95% CI = 1.27–2.62) or a higher number of children (HR = 0.86; 95% CI = 0.78–0.96), balance problems (HR = 1.72; 95% CI = 1.19–2.47), malnutrition or risk thereof (HR = 1.93; 95% CI = 1.24–3.01), and dementia syndrome (HR = 1.88; 95% CI = 1.32–2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR = 1.92; 95% CI = 1.17–3.16), delirium (HR = 1.80; 95% CI = 1.24–2.62), and a high level of comorbidity (HR = 1.62; 95% CI = 1.09–2.40). Institutionalization (HR = 1.92; 95% CI = 1.37–2.71) and unplanned readmission (HR = 4.47; 95% CI = 3.16–2.71) within the follow-up period were also found as independent predictors. Conclusion The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects’ prognosis favorably.

Introduction La chute des personnes âgees est une problematique frequente, souvent symptomatique d’un etat de fragilite. Afin de permettre aux urgentistes de s’approprier les recommandations de la Haute Autorite de sante (HAS), un programme de formation a ete propose a un echelon regional. Methodes Etude multicentrique selon une methode d’observation avant-apres la mise en place d’un programme qualite dans les services d’urgence. Les dossiers medicaux des patients ont ete consultes de maniere retrospective par tirage au sort en 2010 puis en 2012. Resultats Treize centres ont participe a cette evaluation, 2426 patients chuteurs ont ete inclus en 2010 et 2684 en 2012. En 2012, il a ete constate que les dossiers des urgences contenaient davantage d’informations sur les facteurs de fragilite et que les examens recommandes avaient ete plus souvent realises : pour les ECG 53 % en 2010 versus 64 % en 2012 (p Conclusion Ce programme a ete ressenti comme positif par les urgentistes. Sa mise en place a permis de favoriser les relations entre urgentistes et geriatres. Il n’a pas ete possible de comparer l’evolution de la prise en charge dans des centres temoins n’ayant pas beneficie du programme.