Predicting mortality of psychogeriatric patients: a simple prognostic frailty risk score
- E Pijpers1,
- I Ferreira1,2,3,4,
- R J J van de Laar1,3,4,
- C D A Stehouwer1,4,
- A C Nieuwenhuijzen Kruseman1
- 1Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- 2Department of Clinical Epidemiology and Medical Technology Assessment, (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands
- 3Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
- 4Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Correspondence to Dr E Pijpers, Department of Internal Medicine, University Hospital Maastricht, PO Box 5800, 6202AZ Maastricht, The Netherlands;
- Received 17 July 2008
- Accepted 23 April 2009
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.
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.