Utility of Geriatric Syndrome Indicators for Predicting Subsequent Health Care Utilization in Older Adults in Taiwan.

Ching-Ju Chiu,Ya-Yun Cheng

doi:10.3390/ijerph16030456

Abstract

Background: The predictive utility of both individual and combined indicators of geriatric syndromes on subsequent emergency use and hospitalization is not clear. Methods: Nationally representative data on adults aged 65+ (N = 2345) (with 1148 male, 1197 female) in Taiwan were analyzed. The receiver operating characteristic (ROC) curve examined the diagnostic accuracy of the combined effects of geriatric syndromes on predicting health care utilization in three years. Negative binomial regressions identified the individual effect of each indicator with the control of sociodemographic and baseline health status. Results: The combined indicators of geriatric syndromes predicted future hospitalization of old-old (75+ yrs) diabetes patients, with area under the curve (AUC) = 0.709, 95% confidence interval (CI) = 0.635–0.782, and young-old patients (65–74 yrs) with mild cognitive impairment (AUC = 0.727, 95% CI = 0.610–0.845 for hospitalization and AUC = 0.770, 95% CI = 0.664–0.877 for emergency visits). As for individual indicators, while incontinence was the indicator having the most influence on hospitalization (incidence rate ratio (IRR) = 1.81, 95% CI = 1.21–2.72) and emergency visits (IRR = 1.78, 95% CI = 1.23–2.59) for general older adults (65+), and for old-old emergency visits, especially (IRR = 2.21, 95% CI = 1.39–3.49), falls was the most prominent indicator of hospitalization for young-old (65-74) adults (IRR = 1.61, 95% CI = 1.13–2.28). In addition, pain was another significant indicator for predicting future hospitalization of old-old diabetes patients (IRR = 1.61, 95% CI= 1.07–2.44). Conclusions: Combined indicators of geriatric syndromes effectively predict hospitalization in old-old (75+ yrs) diabetes patients and hospitalization and emergency visits in young-old (65–74 yrs) patients with cognitive impairment. Incontinence, falls, and pain were the most predictive independent geriatric assessment indicators.

Highlights

The emergence in old age of several complex health states that do not fall into discrete disease categories are commonly called geriatric syndromes
The combined geriatric syndrome indicators in 2011 were significantly associated with 2012–2014 hospitalizations among older (75+ yrs) diabetes patients (AUC = 0.709, 95% confidence interval (CI) = 0.635–0.782), and the emergency visits (AUC = 0.770, 95% CI = 0.664–0.877) or hospitalizations
Incontinence was the most prominent factor in predicting emergency visits in the three-year follow-up (IRR = 1.78, 95% CI = 1.23–2.59)

Summary

Introduction

The emergence in old age of several complex health states that do not fall into discrete disease categories are commonly called geriatric syndromes. These complex health conditions are not exactly defined and generally include frailty, incontinence, falls, cognitive impairment, functional impairment, diabetes, depression, delirium, and pressure ulcers. The predictive utility of both individual and combined indicators of geriatric syndromes on subsequent emergency use and hospitalization is not clear. The receiver operating characteristic (ROC) curve examined the diagnostic accuracy of the combined effects of geriatric syndromes on predicting health care utilization in three years.

Methods

Results

Discussion

Conclusion