Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 70101, Taiwan.
School of Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 70101, Taiwan.
Int J Environ Res Public Health. 2019 Feb 4;16(3):456. doi: 10.3390/ijerph16030456.
The predictive utility of both individual and combined indicators of geriatric syndromes on subsequent emergency use and hospitalization is not clear.
Nationally representative data on adults aged 65+ (N = 2345) (with 1148 male, 1197 female) in Taiwan were analyzed. The receiver operating characteristic (ROC) curve examined the diagnostic accuracy of the combined effects of geriatric syndromes on predicting health care utilization in three years. Negative binomial regressions identified the individual effect of each indicator with the control of sociodemographic and baseline health status.
The combined indicators of geriatric syndromes predicted future hospitalization of old-old (75+ yrs) diabetes patients, with area under the curve (AUC) = 0.709, 95% confidence interval (CI) = 0.635⁻0.782, and young-old patients (65-74 yrs) with mild cognitive impairment (AUC = 0.727, 95% CI = 0.610⁻0.845 for hospitalization and AUC = 0.770, 95% CI = 0.664⁻0.877 for emergency visits). As for individual indicators, while incontinence was the indicator having the most influence on hospitalization (incidence rate ratio (IRR) = 1.81, 95% CI = 1.21⁻2.72) and emergency visits (IRR = 1.78, 95% CI = 1.23⁻2.59) for general older adults (65+), and for old-old emergency visits, especially (IRR = 2.21, 95% CI = 1.39⁻3.49), falls was the most prominent indicator of hospitalization for young-old (65-74) adults (IRR = 1.61, 95% CI = 1.13⁻2.28). In addition, pain was another significant indicator for predicting future hospitalization of old-old diabetes patients (IRR = 1.61, 95% CI= 1.07⁻2.44).
Combined indicators of geriatric syndromes effectively predict hospitalization in old-old (75+ yrs) diabetes patients and hospitalization and emergency visits in young-old (65⁻74 yrs) patients with cognitive impairment. Incontinence, falls, and pain were the most predictive independent geriatric assessment indicators.
老年综合征的个体和综合指标对随后的急诊使用和住院的预测效用尚不清楚。
对来自中国台湾的 2345 名 65 岁及以上成年人（1148 名男性，1197 名女性）进行了全国代表性数据分析。受试者工作特征（ROC）曲线检查了老年综合征综合效应预测三年内医疗保健利用的诊断准确性。负二项回归确定了每个指标在控制社会人口统计学和基线健康状况后的个体影响。
老年综合征的综合指标预测了老年（75 岁以上）糖尿病患者未来的住院治疗，曲线下面积（AUC）为 0.709，95%置信区间（CI）为 0.635-0.782，年轻老年（65-74 岁）轻度认知障碍患者（AUC=0.727，95%CI=0.610-0.845 用于住院治疗和 AUC=0.770，95%CI=0.664-0.877 用于急诊就诊）。对于个体指标，虽然失禁是对所有老年人（发生率比（IRR）=1.81，95%CI=1.21-2.72）和急诊就诊（IRR=1.78，95%CI=1.23-2.59）住院治疗影响最大的指标，对于老年患者的急诊就诊，特别是（IRR=2.21，95%CI=1.39-3.49），跌倒对年轻老年人（65-74 岁）的住院治疗是最显著的指标（IRR=1.61，95%CI=1.13-2.28）。此外，疼痛也是预测老年糖尿病患者未来住院的另一个重要指标（IRR=1.61，95%CI=1.07-2.44）。
老年综合征的综合指标可有效预测老年（75 岁以上）糖尿病患者的住院治疗以及认知障碍的年轻老年人（65-74 岁）的住院治疗和急诊就诊。失禁、跌倒和疼痛是最具预测性的独立老年评估指标。
