Predictivity of the comorbidity indices for geriatric syndromes

Canaslan, Kubra; Bulut, Esra Ateş; Koçyiğit, Süleyman Emre; Aydın, Ali Ekrem; Işık, Ahmet Turan

doi:10.1186/s12877-022-03066-8

Cited by 22 publications

(20 citation statements)

References 43 publications

(51 reference statements)

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“…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.…”

Section: Discussionsupporting

confidence: 79%

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

et al. 2022

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BackgroundThe assessment process of elderly people considers all aspects of an individual’s life, including physical, mental, and social aspects. Frailty refers to a decline in physiological functions or strengths leading to increased vulnerability to stressors and decreased ability to cope with them. Comprehensive Geriatric Assessment (CGA) is a validated and useful tool in this context to holistically study elderly people. The primary aim of this study was to determine the prevalence of impaired health status in a large geriatric population turning to outpatient service, based on the components of the CGA, and thus to describe its usefulness in real-life clinical practice. The secondary aim of this study was the evaluation of the association between nutritional status, assessed with Mini Nutritional Assessment (MNA)—within the CGA—and cognitive-affective and functional capacities, and multimorbidity.Materials and methodsThis real-life, retrospective cross-sectional study included subjects consecutively evaluated from January 2009 to December 2020 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy. A sum of 3,260 patients were subjected to CGA.ResultsOnly a small proportion of the sample (2.24%) showed an absence of impairment in cognitive-affective, functional, and nutritional domains. Moderate correlations were found between MNA and several other CGA variables, namely, Geriatric Depression Scale (GDS; ϱ = −0.41, p < 0.0001), Barthel Index of Independence in Activities of Daily Living (ADL) (ϱ = 0.51, p < 0.0001), Instrumental Activities of Daily Living (IADL) (ϱ = 0.43, p < 0.0001), and Performance-Oriented Mobility Assessment (ϱ = 0.44, p < 0.0001). A multiple regression also highlighted these variables as significant regressors of MNA. Finally, malnutrition showed a significant association with depression (odds ratio [OR]: 4.97), dependence on ADL (OR: 19.8) and IADL (OR: 7.04), and falling risk (OR: 5.16).ConclusionThis study has figured out the complex situation in which geriatric care finds itself the complexity and severe impairment of elderly people. The possibilities of intervention are often limited, but the literature confirms the benefits of good nutritional status on the general health status. The data that emerged from our study fit into this assumption, highlighting the close association between the nutritional domain and the other CGA domains.

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Section: Discussionsupporting

confidence: 79%

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

et al. 2022

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Care Need Combinations for Dementia Patients with Multiple Chronic Diseases

Jhang¹,

Wang²,

Cheng³

et al. 2023

PRBM

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Purpose The purpose of this study was to find care need combinations for dementia patients with multiple chronic diseases and their caregivers. Patients and Methods A cross-sectional study was conducted with 83 patients who had multiple chronic diseases. Variables from patients included age, gender, severity of clinical dementia rating, feeding, hypnotics, mobility, getting lost, mood symptoms, and behavioral and psychological symptoms. Moreover, 26 types of care needs were included in this study. The Apriori algorithm was employed to first identify care need combinations and then to find the relationships between care needs and variables from dementia patients with multiple chronic diseases. Results Six rules were generated for care need combinations. Four care needs could be formed as a basic care need bundle. Moreover, two additional care needs could be added to provide a wider coverage for patients. In the second stage, 93 rules were found and categorized into three groups, including 2, 6, and 28 general rules with support of 30% but less than 40%, 20% but less than 30%, and 10% but less than 20%, respectively. When the support value is 10% but less than 20%, more variables from patients were found in rules which help the dementia collaborative care team members provide tailor-made care need bundles. Conclusion Four basic care needs were social resources referral and legal support (Care (1)), drug knowledge education (Care (3)), memory problem care (Care (5)), and fall prevention (Care (8)). Besides, disease knowledge education (Care (2)) and hypertension care (Care (16)) were frequent unmet needs in this specific population. Moreover, care for the mood of the caregiver (Care (11)) should be considered especially in dementia patients with preserved ambulatory function or with symptoms of hallucination. The collaborative care team should pay more attention to those care needs when assessing this specific population.

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“…9 Although these multimorbidity indices are both associated with elements of comprehensive geriatric assessment such as frailty, dementia, polypharmacy, or malnutrition, key elements such as sensory deficits, functional independence or mobility problems, and nutritional deficiency may not be sufficiently captured. 39 Previous reviews have shown that proxy scores based on electronic health records perform similarly to many vali- dated clinical tools. 10,16 Although there is a strong case for preferring the frailty and multidomain assessment framework for risk stratification of older patients in acute care over multimorbidity, 40,41 these 2 approaches are possibly complementary.…”

Section: Discussionmentioning

confidence: 99%

Combining the Hospital Frailty Risk Score With the Charlson and Elixhauser Multimorbidity Indices to Identify Older Patients at Risk of Poor Outcomes in Acute Care

Gilbert,

Cordier,

Polazzi

et al. 2023

Medical Care

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Objective: The Hospital Frailty Risk Score (HFRS) can be applied to medico-administrative datasets to determine the risks of 30-day mortality and long length of stay (LOS) in hospitalized older patients. The objective of this study was to compare the HFRS with Charlson and Elixhauser comorbidity indices, used separately or combined. Design: A retrospective analysis of the French medical information database. The HFRS, Charlson index, and Elixhauser index were calculated for each patient based on the index stay and hospitalizations over the preceding 2 years. Different constructions of the HFRS were considered based on overlapping diagnostic codes with either Charlson or Elixhauser indices. We used mixed logistic regression models to investigate the association between outcomes, different constructions of HFRS, and associations with comorbidity indices. Setting: 743 hospitals in France. Participants: All patients aged 75 years or older hospitalized as an emergency in 2017 (n=1,042,234). Main outcome measures: 30-day inpatient mortality and LOS >10 days. Results: The HFRS, Charlson, and Elixhauser indices were comparably associated with an increased risk of 30-day inpatient mortality and long LOS. The combined model with the highest c-statistic was obtained when associating the HFRS with standard adjustment and Charlson for 30-day inpatient mortality (adjusted c-statistics: HFRS=0.654; HFRS + Charlson = 0.676) and with Elixhauser for long LOS (adjusted c-statistics: HFRS= 0.672; HFRS + Elixhauser =0.698). Conclusions: Combining comorbidity indices and HFRS may improve discrimination for predicting long LOS in hospitalized older people, but adds little to Charlson’s 30-day inpatient mortality risk.

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Predictivity of the comorbidity indices for geriatric syndromes

Cited by 22 publications

References 43 publications

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

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

Care Need Combinations for Dementia Patients with Multiple Chronic Diseases

Combining the Hospital Frailty Risk Score With the Charlson and Elixhauser Multimorbidity Indices to Identify Older Patients at Risk of Poor Outcomes in Acute Care

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