Development of a Predictive Score for Mortality at 3 and 12 Months After Discharge From an Acute Geriatric Unit as a Trigger for Advanced Care Planning

Abstract

Background There is a need for a mortality score that can be used to trigger advanced care planning among older patients discharged from acute geriatric units (AGUs). Objective To develop a prognostic score for 3- and 12-month mortality after discharge from an AGU, based on a comprehensive geriatric assessment, in-hospital events, and the exclusion of patients already receiving palliative care. Methods DAMAGE is a French multicentre, prospective, cohort study. The broad inclusion criteria ensured that the cohort is representative of patients treated in an AGU. The DAMAGE participants underwent a comprehensive geriatric assessment, a daily clinical check-up, and follow-up visits 3 and 12 months after discharge. Multivariable logistic regression models were used to develop a prognostic score for the derivation and validation subsets. Results 3509 patients were assessed and 3112 were included. The patient population was very older and frail or dependant, with a high proportion of deaths at 3 months (n=455, 14.8%) and at 12 months (n=1014, 33%). The score predicted an individual risk of mortality ranging from 1% to 80% at 3 months and between 5% and 93% at 12 months, with an area under the receiving operator characteristic curve in the validation cohort of 0.728 at 3 months and 0.733 at 12 months. Conclusions Our score predicted a broad range of risks of death after discharge from the AGU. Having this information at the time of hospital discharge might trigger a discussion on advanced care planning and end-of-life care with very old, frail patients.

Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort

“…The DAMAGE study’s methodology has been described in detail elsewhere. 15 , 16 The main goal of the DAMAGE cohort was to study outcomes after a stay in the UGA and we included 3509 patients for the primary objective analysis. This study is a post-hoc analysis.…”

Predictors of 2-Year Post-Discharge Mortality in Hospitalized Older Patients

“…Previous studies have repeatedly identified older age [ 7 , 8 ], male gender [ 7 , 8 ], multimorbidity [ 7 , 8 , 9 ], polypharmacy [ 7 ], poor nutritional status [ 8 , 10 , 11 , 12 ], cognitive impairment [ 7 , 13 ], depressive symptoms [ 8 , 13 ], frailty [ 9 , 14 ], and poor functional status or locomotor capacity [ 7 , 14 , 15 ] as independent risk factors for all-cause mortality in older patients after hospital stay. However, research into the significance of patients’ mobility-related behavior during hospital stay as a potentially treatment-modifiable risk factor for post-discharge mortality is scarce.…”