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Predicting mortality of psychogeriatric patients: a simple prognostic frailty risk score
  1. E Pijpers1,
  2. I Ferreira1,2,3,4,
  3. R J J van de Laar1,3,4,
  4. C D A Stehouwer1,4,
  5. A C Nieuwenhuijzen Kruseman1
  1. 1
    Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2
    Department of Clinical Epidemiology and Medical Technology Assessment, (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3
    Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
  4. 4
    Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
  1. Correspondence to Dr E Pijpers, Department of Internal Medicine, University Hospital Maastricht, PO Box 5800, 6202AZ Maastricht, The Netherlands; epij{at}sint.azm.nl

Abstract

Background and aims: Frailty and mortality in psychogeriatric patients are hard to predict but important in counselling and therapeutic decision making. We have therefore developed a simple frailty risk score to predict mortality this population.

Study design: Prospective observational study including 401 community dwelling psychogeriatric patients (249 women; mean (SD) age 78.0 (6.5) years), who had been referred to a multidisciplinary diagnostic observation centre. We used Cox proportional hazards regression models to identify and select baseline characteristics for the development and validation of a risk score for the prediction of 3 year mortality.

Results: A total of 116 subjects died during follow-up (median follow-up duration of 26 months). Baseline characteristics associated with mortality were: age (hazard ratio (HR) 1.44, 95% confidence interval (CI)1.02 to 2.04), male sex (HR 2.93, 95% CI 1.89 to 4.59), living alone (HR 1.53, 95% CI 0.99 to 2.38), body mass index (BMI) <18.5 kg/m2 (HR 4.09, 95% CI 2.06 to 8.14), cardiovascular disease (HR 1.42, 95% CI 0.94 to 2.15), elderly mobility score <20 (HR 1.92, 95% CI 1.24 to 2.98), number of medicines ⩾2 (HR 2.28, 95% CI 1.21 to 4.31), and impaired motor (HR 1.47, 95% CI 0.93 to 2.32) and process skills (HR 1.92, 95% CI 1.12 to 2.98) in activities of daily living. These predictors were translated into an easy-to-use frailty risk score and patients were stratified into very good (<45 points), good (45–50) moderate (51–55), poor (56–61) and very poor (>61) prognosis groups. Three year mortality rates across these groups were 8.0%, 15.9%, 25.9%, 41.5%, and 68.8%, respectively (p<0.001). The area under the receiver operating characteristic curve (AUC) of the risk score was 0.78 (95% CI 0.73 to 0.82), indicating good discriminative performance.

Conclusions: We developed and validated a risk score for the prediction of 3 year mortality. This risk score can be used to stratify patients into different risk categories, thereby informing patient counselling and tailored diagnostic and therapeutic decisions in clinical practice.

  • frailty
  • mortality
  • psychogeriatric patients
  • risk score

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Footnotes

  • Funding IF’s research activities are supported by a post-doc research grant (#2006T050) from the Netherlands Heart Foundation.

  • Competing interests none.

  • Patient consent Obtained

  • Provenance and peer review Not commissioned; externally peer reviewed.

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