Prognostic value of assessment tools on elderly patients with chronic advanced disease and end of life, admitted to an intermediate care centre

• Published in: Revista española de geriatría y gerontología Vol. 53; no. 2; pp. 77 - 80
• Main Authors: da Costa, Elizabeth, Robles, María José, Sánchez-Rodríguez, María Dolores, Vázquez-Ibar, Olga, Miralles, Ramón
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.03.2018
• Subjects: Age Factors; Aged; Chronic Disease - mortality; Female; Geriatric Assessment; Hospitalization; Humans; Intermediate Care Facilities; Male; Prognosis; Paciente crónico complejo; Mortality; Mortalidad; Atención paliativa; Complex chronic patients; Palliative care needs; Factores pronósticos; Prognostic factors
• ISSN: 1578-1747
• DOI: 10.1016/j.regg.2017.06.011

To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality. The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients. The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P<.001 and P≤.06, respectively). Correlations between the 3tools: quantitative (Spearman) number of responses in NECPAL with PROFUND (r=.57; P<.001); with Charlson (r=.214; P<.047) and between PROFUND and Charlson (r=.157; P=.148). Qualitative (kappa) NECPAL (positive/negative) with PROFUND (cut-off 6/7) (0.40; P<.001), and Charlson (cut-off 3/4) (0.19; P=.080) and between PROFUND and Charlson (0.08; P=.399). Mortality prediction (area under the curve): NECPAL 3 months 0.81 (95% CI: 0.62-1.00); 6 months 0.71 (95% CI: 0.53-0.89) and 12 months 0.67 (95% CI: 0.52-0.82). PROFUND 3 months 0.71 (95% CI: 0.50-0.91); 6 months 0.73 (95% CI: 0.58-0.87), and 12 months 0.69 (95% CI: 0.57-0.81). Charlson 3 months 0.72 (95% CI: 0.52-0.91); 6 months 0.62 (95% CI: 0.45-0.80), and 12 months 0.64 (95% CI: 0.50-0.78). The 3tools were significantly associated with high mortality. A low concordance was found between the results of the different tools.