Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital |
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| Institution: | 1. Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy;2. Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy;3. Scientific Direction, IRCCS INRCA, Ancona, Italy;4. Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Università Cattolica del Sacro Cuore, Rome, Italy;5. Geriatric Epidemiology Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy;6. Geriatria, Accettazione Geriatrica e Centro di ricerca per l''invecchiamento, IRCCS INRCA, Ancona, Italy;7. Cardiology Unit, IRCCS INRCA, Ancona, Italy;8. Neurology Unit, IRCCS INRCA, Ancona, Italy;9. Geriatrics Operative Unit, Italian National Research Centre on Aging (IRCCS INRCA), Fermo, Italy;1. Thematic Area for Frailty and Healthy Ageing of the Network of Biomedical Research Centers (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain;2. Geriatric Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain;3. Biomedical Research Foundation, Hospital Universitario de Getafe, Madrid, Spain;4. Geriatric Department, Hospital Universitario de Getafe, Madrid, Spain |
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| Abstract: | ObjectivesThe purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals.DesignA prospective multicenter observational study.Setting and ParticipantsOur series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project.MethodsAfter signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell’s C-index and categorical Net Reclassification Index (NRI).ResultsFunctional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy C-index 0.66, 95% confidence interval (CI) 0.65–0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53–0.56), and Charlson score (C-index 0.58, 95% CI 0.56–0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14–0.31) or Charlson score (NRI 0.13, 95% CI 0.03–0.20) to functional cluster model slightly improved the accuracy of prediction.Conclusions and ImplicationsFunctional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals’ needs and to design tailored preventive interventions. |
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| Keywords: | Multimorbidity functional impairment comprehensive geriatric assessment personalized treatment |
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