Assistance Publique-Hôpitaux de Paris.Nord, Bretonneau University Hospital, Geriatric day hospital, 23 rue Joseph de Maistre, 75018, Paris, France.
Université Paris Cité, Paris, France.
BMC Geriatr. 2023 Jan 30;23(1):54. doi: 10.1186/s12877-023-03776-7.
Parkinson's disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD.
Retrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years).
We included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66-0.96), p = .023) and older age (HR = 1.12 95%CI (1.01-1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions.
Age and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.
帕金森病（PD）与 3 倍的死亡率风险相关，这与年龄增长密切相关。在患有晚期帕金森病的老年患者中，缺乏关于与死亡率或养老院（NH）入院相关的因素的证据。我们旨在确定与这些结果相关的临床特征，在年龄较大的社区居住的老年 PD 患者中。
回顾性观察性分析老年日间医院患者的数据。运动评估包括统一帕金森病评定量表（UPDRS）第三部分评分、Tinetti 表现导向的移动评估（POMA）平衡和步态测试以及步态速度。左旋多巴等效剂量、合并症、认知表现、日常生活活动表现进行了检查。进行 Cox 比例风险模型以确定与死亡率和 NH 入院率相关的因素（最大随访时间= 5 年）。
我们纳入了 98 名患者，平均年龄 79.4（SD=5.3），其中 18 名（18.3%）死亡，19 名（19.4%）入住 NH，中位随访时间为 4 年。在多变量 Cox 模型中，Tinetti POMA 量表上的平衡不良（HR=0.82 95%CI（0.66-0.96），p=0.023）和年龄较大（HR=1.12 95%CI（1.01-1.25），p=0.044）是唯一与死亡率风险增加相关的变量。Tinetti 平衡评分为 11/16 以下与死亡风险增加 6.7 倍相关（p=0.006）。没有特定的因素与 NH 入院相关。
年龄和 Tinetti POMA 评分是与死亡率独立相关的唯一因素。在该人群中，Tinetti POMA 量表应考虑用于平衡评估和作为高危个体的筛查工具。
