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Comorbidity in aging and dementia: scales differ, and the difference matters
Soo Borson1, James M Scanlan, Mary Lessig
1Alzheimer's Disease Research Center Satellite, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, 98195-6560, USA. soob@uw.edu
Summary
The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) is more sensitive to comorbidity burden in older adults than the Chronic Disease Score (CDS). Dementia amplifies discrepancies between these scales, impacting healthcare cost assessments.
Area of Science:
- Gerontology
- Epidemiology
- Health Services Research
Background:
- Accurate assessment of dementia's impact on healthcare utilization and costs is challenging.
- Existing studies often fail to adequately separate dementia effects from comorbid conditions.
Purpose of the Study:
- To compare the performance of two comorbidity and risk adjustment scales: the Chronic Disease Score (CDS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G).
- To evaluate these scales in older individuals with and without dementia.
Main Methods:
- Analysis of data from 619 participants in a University of Washington diagnostic program.
- Examined CDS and CIRS-G scores (excluding neuropsychiatric disorders) across age, education, and cognitive status (normal, impaired, demented).
- Utilized analysis of variance, analysis of covariance, and linear regression.
Main Results:
- CIRS-G scores significantly correlated with age, education, and cognitive status, unlike the CDS.
- Even with CDS scores of zero, CIRS-G scores varied significantly across demographic and cognitive groups.
- Regression analyses indicated an interaction between CDS, cognitive status, and CIRS-G scores, with dementia amplifying discrepancies.
Conclusions:
- Comorbidity measurement methods are not interchangeable, with dementia exacerbating differences.
- Using the CDS to adjust for comorbidity in dementia studies may underestimate disease burden and overestimate dementia-related costs.
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