Department of Internal Medicine, Geriatric Medicine Section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands,
Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands,
Gerontology. 2021;67(2):194-201. doi: 10.1159/000512048. Epub 2021 Jan 13.
In older patients, life expectancy is determined by a complex interaction of multiple geriatric domains. A comprehensive geriatric assessment (CGA) captures different geriatric domains. Yet, if and how components of the CGA are related to mortality in an outpatient geriatric setting is unknown. In the Amsterdam Ageing Cohort, we therefore studied distribution and accumulation of geriatric domain deficits in relation to mortality.
All patients received a CGA as part of standard care, independent of referral reason. We summarized deficits on the CGA, using predefined cutoffs, in 5 geriatric domains: somatic, mental, nutritional, physical, and social domain. Information on mortality was obtained from the Dutch municipal register. We used age- and sex-adjusted Cox proportional hazards analyses to relate the separate domains and accumulation of impaired domains to overall mortality.
From the 1,055 geriatric outpatients (53% female; age 79 ± 7 years), 172 patients (16%) had died after 1.7 ± 1.1 years. In 626 patients (59%), 3 or more domains were impaired. All domains were independently associated with mortality, with the highest hazard for the somatic domain (HR 3.7 [1.7-8.0]) and the lowest hazard for the mental domain (HR 1.5 [1.1-12.0]). In addition, accumulation of impaired domains showed a gradually increased mortality risk, ranging from HR 2.2 (0.8-6.1) for 2 domains to HR 9.6 (3.7-24.7) for all 5 domains impaired.
This study provides evidence that impairment in multiple geriatric domains is highly prevalent and independently and cumulatively associated with mortality in an outpatient geriatric setting.
在老年患者中，预期寿命取决于多个老年医学领域的复杂相互作用。全面老年评估（CGA）可以捕获不同的老年医学领域。然而，在门诊老年环境中，CGA 的各个组成部分与死亡率之间的关系如何，目前还不得而知。因此，在阿姆斯特丹老年队列研究中，我们研究了老年医学领域缺陷的分布和积累与死亡率的关系。
所有患者都接受了 CGA 作为标准护理的一部分，无论转诊原因如何。我们使用预定义的截止值，总结了 5 个老年医学领域的 CGA 缺陷：躯体、心理、营养、身体和社会领域。死亡率信息来自荷兰市登记处。我们使用年龄和性别调整的 Cox 比例风险分析，将单独的领域和受损领域的积累与总体死亡率相关联。
从 1055 名老年门诊患者（53%为女性；年龄 79 ± 7 岁）中，有 172 名患者（16%）在 1.7 ± 1.1 年后死亡。在 626 名患者（59%）中，有 3 个或更多领域受损。所有领域都与死亡率独立相关，躯体领域的风险最高（HR 3.7 [1.7-8.0]），心理领域的风险最低（HR 1.5 [1.1-12.0]）。此外，受损领域的积累显示出逐渐增加的死亡率风险，从 2 个领域的 HR 2.2（0.8-6.1）到所有 5 个领域受损的 HR 9.6（3.7-24.7）。
这项研究提供了证据表明，在门诊老年环境中，多个老年医学领域的功能障碍非常普遍，并且与死亡率独立且累积相关。
