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Comorbidity burden assessment in older people admitted to a Portuguese University Hospital
Ana Dias1, Francisca Teixeira-Lopes, Ana Miranda
1Respiratory Medicine Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal, ana.pgrdias@gmail.com.
Insights
The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and Charlson Comorbidity Index (CCI) effectively predict mortality and readmission in older patients. The Medication-Based Disease Burden Index (MDBI) showed no significant association with these outcomes.
Area of Science:
- Geriatric Medicine
- Clinical Epidemiology
- Health Services Research
Background:
- Comorbidity assessment is crucial for predicting outcomes in older adults.
- Evaluating the effectiveness of different comorbidity indices in clinical practice is essential.
- Understanding trends in older patient admissions and their associated health outcomes over time is important.
Purpose of the Study:
- To identify the most valuable comorbidity index for clinical use.
- To assess the prospective association of comorbidity indices with 1-year mortality and 3-month readmission.
- To analyze the changes in the admission profile of older patients over a 13-year period.
Main Methods:
- Analysis of data from 100 consecutive patients admitted in 2012.
- Utilized Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and Medication-Based Disease Burden Index (MDBI) for comorbidity evaluation.
- Assessed length of stay, number of diagnoses, number of medications, readmission rates, and mortality.
Main Results:
- Higher CCI and CIRS-G scores were associated with increased 3-month readmission and 1-year mortality.
- The MDBI did not show a significant association with the evaluated outcomes.
- One-year mortality was 24%, and 3-month readmission was 43% in the study cohort.
- Over 13 years, the patient population aged, had more diagnoses, but experienced shorter hospital stays.
Conclusions:
- The CIRS-G demonstrated superior comorbidity evaluation compared to CCI and MDBI.
- MDBI was found to be an untrustworthy tool for assessing comorbidity in this context.
- Despite improvements in length of stay, high readmission rates necessitate the implementation of geriatric care standards to enhance health outcomes for older patients.
Purpose:
To determine the most valuable comorbidity index to apply in a clinical context and its prospective association with 1-year mortality and 3-month readmission. The authors also intend to gauge the evolution of older patients' admission profile over 13 years, in the same clinical setting.
Subjects/Materials And Methods:
The authors analyzed data from 100 consecutive patients admitted in 2012. The Charlson Comorbidity Index (CCI), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the Medication-Based Disease Burden Index (MDBI) were used to evaluate comorbidity. Length of stay, number of diagnoses and of medications, readmission and mortality were assessed. A p value <0.05 was considered significant.
Results:
Mean age was 80.6 years, mean length of stay was 8.8 days, and mean number of diagnosis per patient was 7.9. Mean values of score were of 3.6 for the CCI, 11.3 for the CIRS-G and 0.552 for the MDBI. Three-month readmission and 1-year mortality rates related to higher CCI and CIRS-G scores. No association was found between MDBI and the outcomes evaluated. One-year mortality reached 24 % and 3-month readmission was of 43 %. Comparing the two samples, mean age increased in 2.1 years and the number of diagnosis by 2.2. Length of stay decreased 2 days.
Discussion And Conclusion:
CCI was easier to use but the CIRS-G was better at evaluating comorbidity. MDBI did not seem to be a trustworthy tool. Despite an older population with high comorbidity, length of stay decreased over 13 years. However, readmission was high. Introduction of geriatric care standards is required to improve health outcomes for older patients.