Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany.
Aging Clin Exp Res. 2020 Jan;32(1):115-124. doi: 10.1007/s40520-019-01168-9. Epub 2019 Mar 25.
Geriatric syndromes (GS) do not fit into discrete disease categories and are often underdiagnosed in hospitalized older adults. Geriatric resources (GR) are also not routinely collected in clinical settings, although this may potentiate the beneficial effects of clinical decisions. The prognostic relevance of GS and GR has never been systematically evaluated through clinical tools developed for clinical decision purposes.
To ascertain the impact of common GS and GR on patients' prognosis as assessed by means of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI).
One hundred and thirty-five hospitalized patients aged 70 years and older underwent a CGA evaluation with calculation of the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI-1, score 0-0.33), moderate (MPI-2, score 0.34-0.66), and severe (MPI-3, score 0.67-1)-risk of mortality at 1 month and 1 year. Nine GR and 17 GS were identified and collected accordingly.
A lower number of GS and a higher number of GR were shown to be highly significantly correlated with a lower MPI, as well as years of education, grade of care, and number of medications independent of age, sex and number of GS or GR. Underweight and obesity according to the BMI were significantly correlated to higher number of GS. Patients with more GR had a significantly higher chance of being discharged home.
The MPI evaluation together with GS and GR in acute care for older patients should be encouraged to improve clinical decision-making.
老年综合征（GS）不符合离散疾病类别，且在住院老年人中经常被漏诊。老年资源（GR）在临床环境中也没有常规收集，尽管这可能增强临床决策的有益效果。GS 和 GR 的预后相关性从未通过专门为临床决策目的而开发的临床工具进行系统评估。
通过基于全面老年评估（CGA）的多维预后指数（MPI）评估，确定常见 GS 和 GR 对患者预后的影响。
135 名年龄在 70 岁及以上的住院患者接受了 CGA 评估，并在入院和出院时计算了 MPI。因此，患者被分为低危（MPI-1，评分 0-0.33）、中危（MPI-2，评分 0.34-0.66）和高危（MPI-3，评分 0.67-1）-1 个月和 1 年的死亡率。确定了 9 个 GR 和 17 个 GS 并进行了相应的收集。
GS 数量减少和 GR 数量增加与 MPI 降低以及受教育年限、护理级别和用药数量显著相关，且独立于年龄、性别以及 GS 或 GR 的数量。根据 BMI 确定的体重过轻和肥胖与更多 GS 显著相关。GR 更多的患者出院回家的机会显著增加。
应鼓励在老年患者的急性护理中使用 MPI 评估以及 GS 和 GR，以改善临床决策。
