Índice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia

Moreno, Blanca Torres; González, Eduardo Núñez; Hernández, Domingo de Guzmán Pérez; Turriate, Juan Pedro Simón; Giménez, Carmen Alastuey; Melián, Juan Díaz; Rodríguez, Elisa Corujo; Bermúdez, Marı́a-Dolores; Duque, Olga Fernández

doi:10.1016/j.regg.2009.02.002

Cited by 32 publications

(5 citation statements)

References 14 publications

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“…Furthermore, among hospitalized elderly subjects, functional impairment rather than comorbidity and indices of disease burden have been recognized as the strongest predictors of outcomes [36-38]. The Barthel Index could therefore be more useful than other indexes when considering an adequate use of healthcare services [24]. Cognitive impairment is the other pillar of this model, and it has been validated as an excellent predictor of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients

2014

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BackgroundAdvancing age is associated with increased vulnerability to chronic health problems. Identifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies.MethodsObservational prospective study of patients aged 75 years and older consecutively admitted to an Acute Geriatric Ward of a tertiary hospital. After a comprehensive geriatric assessment all patients were assessed for five comorbidity indices and two prognostic models. Univariate and multivariate logistic regression models were fitted to assess the association between each score and 5-year mortality. The ability of each score to predict mortality was assessed using the area under the receiver operating characteristic curve.Results122 patients were enrolled. All patients were followed up for five years. 90 (74%) of them died during the study period. In the logistic regression analyses, apart from age, cognitive impairment and Barthel Index, three indices were identified as statistically associated with 5-year mortality: the Geriatric Index of Comorbidity and the two prognostic indices. The multivariate model that combined age, sex, cognitive impairment and Barthel showed a good discriminate ability (AUC = 0.79), and it did not improve substantially after adding individually any of the indices.ConclusionsSome prognostic models and the Geriatric Index of Comorbidity are better than other widely used indices such as the Charlson Index in predicting 5-year mortality in hospitalized older patients, however, none of these indices is superior to some components of comprehensive geriatric assessment.

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Section: Discussionmentioning

confidence: 99%

Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients

2014

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“…Geriatricians also carried out the initial evaluations, which included an exhaustive review of medical and pharmacological histories and an assessment of the functional abilities and comorbid conditions of the subjects using the Barthel and Charlson indexes, respectively. Both questionnaires have been previously validated and their use demonstrated in an elderly Spanish population [21, 22]. Design and methodology are fully described in a previous publication [23].…”

Section: Methodsmentioning

confidence: 99%

Overweight in the Elderly Induces a Switch in Energy Metabolism that Undermines Muscle Integrity

Potes¹,

Pérez-Martínez²,

Bermejo-Millo³

et al. 2019

Aging and disease

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Aging is characterized by a progressive loss of skeletal muscle mass and function (sarcopenia). Obesity exacerbates age-related decline and lead to frailty. Skeletal muscle fat infiltration increases with aging and seems to be crucial for the progression of sarcopenia. Additionally, skeletal muscle plasticity modulates metabolic adaptation to different pathophysiological situations. Thus, cellular bioenergetics and mitochondrial profile were studied in the skeletal muscle of overweight aged people without reaching obesity to prevent this extreme situation. Overweight aged muscle lacked ATP production, as indicated by defects in the phosphagen system, glycolysis and especially mostly by oxidative phosphorylation metabolic pathway. Overweight subjects exhibited an inhibition of mitophagy that was linked to an increase in mitochondrial biogenesis that underlies the accumulation of dysfunctional mitochondria and encourages the onset of sarcopenia. As a strategy to maintain cellular homeostasis, overweight subjects experienced a metabolic switch from oxidative to lactic acid fermentation metabolism, which allows continued ATP production under mitochondrial dysfunction, but without reaching physiological aged basal levels. This ATP depletion induced early signs of impaired contractile function and a decline in skeletal muscle structural integrity, evidenced by lower levels of filamin C. Our findings reveal the main effector pathways at an early stage of obesity and highlight the importance of mitochondrial metabolism in overweight and obese individuals. Exploiting mitochondrial profiles for therapeutic purposes in humans is an ambitious strategy for treating muscle impairment diseases.

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“…Hence, NHFS, O-Possum, and other indexes have been developed and are in use [5]. Among the various risk factors associated with higher mortality in older patients with hip fracture are biodemographic factors, such as male gender and age, clinical factors such as ASA class for anesthetic risk or comorbidity rates, and care factors such as surgical delay [6, 7], but also previous functional situation could have been related with short-term mortality [8, 9] and some geriatric scores have previously studied as predictors of short-term mortality for patients undergoing surgery [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Geriatric scores can predict long-term survival rate after hip fracture surgery

et al. 2019

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Background The management of hip fractures is nowadays mainly performed in Orthogeriatric Units, one of whose fundamental tools is the application of geriatric scores. The purpose of this study is to establish the potential usefulness of Barthel Index, Katz Index, Lawton-Brody Index and Physical Red Cross Scale geriatric scores as predictors of survival rate and readmission rate in older patients after hip fracture surgery. Methods We designed a prospective single-center observational study, including 207 older adults over age 65 who underwent hip fracture surgery in the first half of 2014 and followed up to September 2018. Cumulative survival and readmission rates were analyzed by Kaplan-Meier; group comparison, by Log-Rank and hazard ratio, by Cox regression. Results We found statistical differences ( p < 0.001) for cumulative survival rate by every geriatric score analyzed (BI HR = 0.98 [0.97,0.99]; KI HR = 1.24 [1.13–1.37]; LBI HR = 1.25 [1.16, 1.36]; PCRS HR = 1.67 [1.37,2.04]). Furthermore, we could determinate an inflection point for survival estimation by Barthel Index (BI 0–55/60–100*, p < 0.001, HR = 2.37 [1.59,3.53]), Katz Index (KI A-B*/C-G, p < 0.001, HR = 2.66 [1.80, 3.93], and Lawton-Brody Index (LBI 0–3/4–8*, p < 0.001, HR = 3.40 [2.09,5.25]). We reveal a correlation of the Charlson Index ( p = 0.002) and Katz Index ( p = 0.041) with number of readmissions for the study period. Conclusions The geriatric scores analyzed are related to the cumulative survival rate after hip fracture surgery for more than 4 years, independently of other clinical and demographic factors. Katz Index in combination with Charlson Index could also be a potential predictor of the number of readmissions after surgery for hip fracture patients. Electronic supplementary material The online version of this article (10.1186/s12877-019-1223-y) contains supplementary material, which is available to authorized users.

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Índice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia

Cited by 32 publications

References 14 publications

Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients

Comorbidity and prognostic indices do not improve the 5-year mortality prediction of components of comprehensive geriatric assessment in hospitalized older patients

Overweight in the Elderly Induces a Switch in Energy Metabolism that Undermines Muscle Integrity

Geriatric scores can predict long-term survival rate after hip fracture surgery

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