Frailty as a predictor of mortality in older adults within 5 years of psychiatric admission
Frailty as a predictor of mortality in older adults within 5 years of psychiatric admission
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DOI：
10.1002/gps.5278
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发表时间：
2020-02-23
影响因子：
4
通讯作者：
Rikkert, Marcel G. M. Olde
中科院分区：
文献类型：
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作者：
Benraad, Carolien E. M.;Haaksma, Miriam L.;Rikkert, Marcel G. M. Olde
目的与年龄匹配的对照组相比，患有精神障碍的老年人的预期寿命显著降低。对风险因素的了解可能导致有针对性的治疗和干预，以缩小预期寿命的这种差距。在这项研究中，我们调查了老年精神病院急性入院后，虚弱是否独立地预测老年患者的死亡率。方法临床队列研究，对2009年2月至2010年9月间入住精神病院的120名老年患者进行5年随访。入院时，我们用脆弱指数(FI)评估脆弱程度。我们以死亡时间为因变量进行COX回归分析，在调整了年龄、性别、教育程度、多病(老年累积疾病评定量表，CIRS-G评分)、功能状态(Barthel指数)、神经精神症状(NPS)和入院时精神症状严重程度(临床总体印象严重程度量表)后，FI是否是死亡率的预测因素。结果120例患者中，63例(53%)虚弱(FI>=0.25)，59例(49%)在5年内死亡。FI预测死亡率的危险比(HR)为1.78(95%CI，1.06-2.98)，与协变量无关。CIRS-G测量的共同发病率和Barthel指数测量的功能状态之间没有显著相关性。结论虚弱是死亡率的一个强有力的预测因素，与年龄、性别、多病和功能状态无关。这意味着脆弱可能有助于根据患者的预期寿命来确定住院精神治疗和后续护理的目标。
Objectives Older adults with psychiatric disorders have a substantially lower life expectancy than age-matched controls. Knowledge of risk factors may lead to targeting treatment and interventions to reduce this gap in life expectancy. In this study, we investigated whether frailty independently predicts mortality in older patients following an acute admission to a geriatric psychiatry hospital.Methods Clinical cohort study with a 5-year follow-up of 120 older patients admitted to a psychiatric hospital between February 2009 and September 2010. On admission, we assessed frailty with a frailty index (FI). We applied Cox regression analyses with time to death as the dependent variable, to examine whether the FI was a predictor for mortality, adjusted for age, sex, level of education, multimorbidity (Cumulative Illness Rating Scale for Geriatrics, CIRS-G scores), functional status (Barthel Index), neuropsychiatric symptoms (NPS), and severity of psychiatric symptoms at admission (Clinical Global Impressions Scale of Severity).Results Of the 120 patients, 63 (53%) patients were frail (FI >= 0.25), and 59 (49%) had died within 5 years. The FI predicted mortality with a hazard ratio (HR) of 1.78 (95% CI, 1.06-2.98) per 0.1 point increase, independent of the covariates. Co-morbidity measured by the CIRS-G and functional status measured by the Barthel Index were not significantly associated.Conclusions Frailty was a strong predictor of mortality, independent of age, gender, multimorbidity, and functional status. This implies that frailty may be helpful in targeting inpatient psychiatric treatment and aftercare according to patients' life expectancy.