Predictive Validity of Measures of Comorbidity in Older Community Dwellers: The Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study

Journal of the American Geriatrics Society - Tập 54 Số 2 - Trang 210-216 - 2006
Mauro Di Bari1,2, Adriana Virgillo1,2, Daniela Matteuzzi1,2, Marco Inzitari1,2, Giampiero Mazzaglia1,2, Cláudia Rodrigues Pozzi1,2, Pierangelo Geppetti1,2, Giulio Masotti1,2, Niccolò Marchionni1,2, Riccardo Pini1,2
1Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
2From the Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, Florence, Italy

Tóm tắt

OBJECTIVES: To compare the ability of five measures of comorbidity to predict mortality and incident disability in basic activities of daily living (BADLs) in unselected older persons.DESIGN: An assessment of the data obtained from the Insufficienza Cardiaca negli Anziani Residenti a Dicomano (ICARe Dicomano) Study, a longitudinal epidemiological survey on heart failure in older people.SETTING: Dicomano, a small, rural town near Florence, Italy.PARTICIPANTS: The entire population aged 65 and older living in Dicomano, Italy, was enrolled in the ICARe Dicomano Study.MEASUREMENTS: At baseline (1995), comorbidity was quantified in 688 participants, based on clinical diagnoses, using disease count (DC), Charlson Comorbidity Index (CCI), Index of Co‐Existent Diseases (ICED), and Geriatric Index of Comorbidity (GIC), or on drug use, using Chronic Disease Score (CDS). Incident ADL disability was assessed in 1999 and vital status in 2004.RESULTS: Mortality increased with the severity of comorbidity, with hazard ratios around 2 when comparing the highest and the lowest quartiles of DC, CCI, and ICED in Cox regressions adjusted for age, sex, and physical and cognitive performance. Prediction of mortality with GIC and CDS was only borderline significant. All measures predicted incident ADL disability; the strongest risk gradient (hazard ratio=8.2 between the highest and lowest quartiles) was observed with ICED. Physical and, to a minor extent, cognitive performance added significantly to predicting mortality and incident BADL disability.CONCLUSION: All the measures of comorbidity predicted death and BADL disability in older community dwellers. DC, CCI, and ICED performed better than GIC and CDS. Physical performance measures are strong, independent contributors to the prediction of these outcomes.

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Tài liệu tham khảo

10.1016/0021-9681(70)90054-8

10.1016/S0895-4356(02)00585-1

10.1016/j.jclinepi.2004.03.002

Harboun M, 2001, Comorbidity indexes, Review of the literature and application to studies of elderly population, 49, 287

10.1097/00005650-199801000-00004

Stineman MG, 1998, Diagnostic coding and medical rehabilitation length of stay, Their relationship, 79, 241

10.1001/archinte.151.11.2201

10.1016/S1047-2797(96)00064-6

10.1097/00005650-199611000-00004

Charlson ME, 1987, A new method of classifying prognostic comorbidity in longitudinal studies, Development and validation, 40, 373

10.1001/jama.1987.03390200106023

Rozzini R, 2002, Geriatric Index of Comorbidity, Validation and comparison with other measures of comorbidity, 31, 277

10.1016/0895-4356(92)90016-G

Bari M, 1999, Heart failure in community‐dwelling older persons, Aims, design and adherence rate of the ICARe Dicomano project: An epidemiologic study. Insufficienza cardiaca negli anziani residenti a Dicomano, 47, 664

Bari M, 1999, Undertreatment of hypertension in community dwelling older adults, A drug-utilization study in Dicomano, Italy, 17, 1633

10.1056/NEJM199503023320902

Heikkinen E, 1983, The Elderly in Eleven Countries. A Socio‐Medical Survey. Public Health in Europe, 21

10.1016/0022-3956(75)90026-6

Brink TL, 1982, Screening test for geriatric depression, Clin Gerontol, 1, 37, 10.1300/J018v01n01_06

10.1093/aje/154.9.854

10.1016/j.archger.2003.09.002

Guralnik JM, 1994, A short physical performance battery assessing lower extremity function, Association with self-reported disability and prediction of mortality and nursing home admission, 49, M85

10.1007/BF03337716

10.1046/j.1532-5415.2003.51453.x

10.1097/00019442-200309000-00010

10.1001/jama.279.21.1720

10.1192/bjp.177.4.336

10.1001/archpsyc.56.10.889

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Journal of the American Geriatrics Society

Tập 54 Số 2

210-216

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