Amblàs-Novellas Jordi, Murray Scott A, Oller Ramon, Torné Anna, Martori Joan Carles, Moine Sébastien, Latorre-Vallbona Nadina, Espaulella Joan, Santaeugènia Sebastià J, Gómez-Batiste Xavier
Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), Vic, Spain
Chair of Palliative Care, University of Vic/Central University of Catalonia (UVIC-UCC), Vic, Spain.
BMJ Open. 2021 Apr 21;11(4):e042645. doi: 10.1136/bmjopen-2020-042645.
To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.
Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014-2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.
Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients).
All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.
评估患有不同晚期疾病的老年人的衰弱程度及其与临终疾病轨迹和生存的关系。
前瞻性观察性研究，纳入西班牙维克大学医院急性老年病科在连续12个月（2014 - 2015年）收治的所有患者，随访长达2年。使用NECPAL（姑息治疗需求）工具将参与者确定为临终患者（EOLp），并根据其主要疾病轨迹进行分类。采用Frail-VIG指数（综合老年评估）量化衰弱程度，计算衰弱与死亡率之间的关系（受试者工作特征（ROC）曲线），并评估衰弱程度和疾病轨迹对生存的联合影响（Cox比例风险模型）。使用Kaplan-Meier估计器绘制生存曲线，将参与者分为四组（即无衰弱、轻度衰弱、中度衰弱和重度衰弱），并使用对数秩检验进行比较。
在招募的590名平均（标准差）年龄为86.4（5.6）岁的患者中，260名（44.1%）被确定为EOLp，分布在癌症（n = 31，11.9%）、器官衰竭（n = 79，30.4%）、痴呆（n = 86，33.1%）和多种疾病并存（n = 64，24.6%）轨迹中。所有260名EOLp都有一定程度的衰弱，大多数为重度衰弱（n = 184，70.8%），无论疾病轨迹如何，220名（84.6%）在2年内死亡。EOLp随访2年后ROC曲线下面积（95%CI）为0.87（0.84至0.92），不同临终轨迹的生存下降模式不同（p < 0.0001）。Cox回归分析表明，Frail-VIG指数每增加一个缺陷，痴呆、器官衰竭、多种疾病并存和癌症患者的死亡风险分别增加61.5%、30.1%、29.6%和12.9%（所有系数p < 0.01）。
本研究中所有临终老年人都存在衰弱，大多数为重度衰弱。尽管不同轨迹的生存模式不同，但衰弱程度与不同疾病轨迹的生存相关。衰弱指数可能有助于评估临终老年人，无论其轨迹如何。
