Abstract
BackgroundAdvancing age is associated with increased vulnerability to chronic health problems. Identifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies.MethodsObservational prospective study of patients aged 75 years and older consecutively admitted to an Acute Geriatric Ward of a tertiary hospital. After a comprehensive geriatric assessment all patients were assessed for five comorbidity indices and two prognostic models. Univariate and multivariate logistic regression models were fitted to assess the association between each score and 5-year mortality. The ability of each score to predict mortality was assessed using the area under the receiver operating characteristic curve.Results122 patients were enrolled. All patients were followed up for five years. 90 (74%) of them died during the study period. In the logistic regression analyses, apart from age, cognitive impairment and Barthel Index, three indices were identified as statistically associated with 5-year mortality: the Geriatric Index of Comorbidity and the two prognostic indices. The multivariate model that combined age, sex, cognitive impairment and Barthel showed a good discriminate ability (AUC = 0.79), and it did not improve substantially after adding individually any of the indices.ConclusionsSome prognostic models and the Geriatric Index of Comorbidity are better than other widely used indices such as the Charlson Index in predicting 5-year mortality in hospitalized older patients, however, none of these indices is superior to some components of comprehensive geriatric assessment.
Highlights
IntroductionIdentifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies
Advancing age is associated with increased vulnerability to chronic health problems
Our previous study showed that comprehensive geriatric assessment (CGA) is a better 1-year mortality predictor than several indices and factors [10], and the objective of the present study is to evaluate the long-term prognostic ability of these factors and indices in order to check their eventual role if added to functional and cognitive measures
Summary
Identifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies. There have been several reviews of prognostic and comorbidity indices for older adults [1,4,7,8,9] These indices try to help in the clinical decision-making process, there is still insufficient evidence at this time to recommend the wide-spread use of prognostic indices in clinical practice. Even the more-common models developed some 25 years ago have not been frequently validated in an older subgroup. The applicability of these models in this increasingly important population merits special attention
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