Predictivity of the comorbidity indices for geriatric syndromes

Abstract

Background The aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes. Methods A total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis. Results Patients’ mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition. Conclusions In the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.

Comprehensive Geriatric Assessment: Application and correlations in a real-life cross-sectional study

“…Nevertheless, this data are consistent with the literature (29-31). Regarding the correlations between the variables, as expected (28), CIRS Tot., CIRS ICC, and CIRS ISC were mutually very strongly correlated with each other-since a single index is insufficient (32), we also summarized the principal comorbidities-, and also the strong relationship between ADL, IADL, and POMA is consistent with the literature (14,33). It is interesting to underline that MNA is the most correlated variable with > 0.4: it is correlated with GDS, ADL, IADL, and POMA.…”

Care Need Combinations for Dementia Patients with Multiple Chronic Diseases

“…Multimorbidity was often accompanied with frailty, polypharmacy, and dementia. 28 , 29 Hung et al 30 found that the comprehensive geriatric assessment guided multidisciplinary interventions (including physical therapy, psychotherapy, pharmacist education, and social resources linkage) were effective to improve frail severity, physical function, and depressive and nutritional status in elderly (45% with dementia). Appropriate intervention toward frail status and polypharmacy maybe also a solution to deal with this complex population.…”

Which comorbidity index is more appropriate for geriatric patients from the frailty perspective?

“…Besides, the Weighted Functional Comorbidity Index (w-FCI), developed in later years, has been shown to better predict functional outcomes than ACCI in geriatric rehabilitation [46]. In a study conducted with hospitalized older patients, a relationship was found between ACCI and dementia, polypharmacy, frailty, malnutrition, slow walking speed, and low muscle strength [13]. In our study, the index showing the highest correlation with age was ACCI, while ACCI scores were correlated with ADL, IADL, and malnutrition.…”