Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults.
Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults.
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DOI：
10.1186/1471-2318-14-129
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发表时间：
2014-12-03
期刊：
影响因子：
4.1
通讯作者：
Jacob-Filho W
中科院分区：
文献类型：
--
作者：
Avelino-Silva TJ;Farfel JM;Curiati JA;Amaral JR;Campora F;Jacob-Filho W
老年综合评估（CGA）提供了老年患者临床、功能和认知方面的详细信息，尤其适用于评估体弱者。虽然大部分住院老年人表现出高度的复杂性，但CGA并不是专门针对这种情况开发的。我们的目的是评估CGA模型在住院老年人临床特征和预后预测中的应用。这是一项前瞻性观察性研究，包括2009年1月至2011年12月期间在巴西圣保罗一所大学医院老年病房住院的746例60岁及以上患者。建议的CGA应用于评估所有患者在入院时。主要结局为院内死亡，次要结局为谵妄、院内感染、功能下降和住院时间。进行多变量二元logistic回归以评估与这些结局相关的独立因素，包括社会人口统计学、临床、功能、认知和实验室变量。特别调查了10个CGA组成部分的损害：多种药物、日常生活活动（ADL）依赖、工具性日常生活活动（IADL）依赖、抑郁、痴呆、谵妄、尿失禁、福尔斯、营养不良和社会支持差。研究的患者大多为女性（67.4%），平均年龄为80.5±7.9岁。多因素Logistic回归分析显示以下独立因素与院内死亡相关：IADL依赖（OR=4.02; CI=1.52-10.58; p=.005）; ADL依赖性（OR=2.39; CI=1.25-4.56; p= 0.008）;营养不良（OR=2.80; CI=1.63-4.83; p<0.001）;社会支持较差（OR=5.42; CI=2.93-11.36; p<0.001）;急性肾损伤（OR=3.05; CI=1.78-5.27; p<0.001）;以及是否存在压疮（OR=2.29; CI=1.04-5.07; p= 0.041）。ADL依赖与谵妄发生率和医院感染独立相关（分别为：OR=3.78; CI=2.30-6.20; p<0.001和OR=2.30; CI=1.49-3.49; p<0.001）。CGA成分受损的数量也与院内死亡（p<0.001）、谵妄发生率（p<0.001）和院内感染（p= 0.005）相关。此外，IADL依赖、营养不良和福尔斯史预测住院时间更长。住院期间，总体功能状态无显著变化。CGA确定了住院死亡和不良结局风险较高的患者，其中功能依赖、营养不良和社会支持差的患者最多。
Comprehensive Geriatric Assessment (CGA) provides detailed information on clinical, functional and cognitive aspects of older patients and is especially useful for assessing frail individuals. Although a large proportion of hospitalized older adults demonstrate a high level of complexity, CGA was not developed specifically for this setting. Our aim was to evaluate the application of a CGA model for the clinical characterization and prognostic prediction of hospitalized older adults. This was a prospective observational study including 746 patients aged 60 years and over who were admitted to a geriatric ward of a university hospital between January 2009 and December 2011, in Sao Paulo, Brazil. The proposed CGA was applied to evaluate all patients at admission. The primary outcome was in-hospital death, and the secondary outcomes were delirium, nosocomial infections, functional decline and length of stay. Multivariate binary logistic regression was performed to assess independent factors associated with these outcomes, including socio-demographic, clinical, functional, cognitive, and laboratory variables. Impairment in ten CGA components was particularly investigated: polypharmacy, activities of daily living (ADL) dependency, instrumental activities of daily living (IADL) dependency, depression, dementia, delirium, urinary incontinence, falls, malnutrition, and poor social support. The studied patients were mostly women (67.4%), and the mean age was 80.5±7.9 years. Multivariate logistic regression analysis revealed the following independent factors associated with in-hospital death: IADL dependency (OR=4.02; CI=1.52-10.58; p=.005); ADL dependency (OR=2.39; CI=1.25-4.56; p=.008); malnutrition (OR=2.80; CI=1.63-4.83; p<.001); poor social support (OR=5.42; CI=2.93-11.36; p<.001); acute kidney injury (OR=3.05; CI=1.78-5.27; p<.001); and the presence of pressure ulcers (OR=2.29; CI=1.04-5.07; p=.041). ADL dependency was independently associated with both delirium incidence and nosocomial infections (respectively: OR=3.78; CI=2.30-6.20; p<.001 and OR=2.30; CI=1.49-3.49; p<.001). The number of impaired CGA components was also found to be associated with in-hospital death (p<.001), delirium incidence (p<.001) and nosocomial infections (p=.005). Additionally, IADL dependency, malnutrition and history of falls predicted longer hospitalizations. There were no significant changes in overall functional status during the hospital stay. CGA identified patients at higher risk of in-hospital death and adverse outcomes, of which those with functional dependence, malnutrition and poor social support were foremost.