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Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?

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Abstract

Background

Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention.

Aims

The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools.

Methods

We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined.

Results

Median age of the patients (415 male, 726 female) was 71.7 years (53–95 years). Mean survival time was 12.2 years (95 % CI; 12–12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09–1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18–5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05–4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71–1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49–1.00, p = 0.052) had borderline significance.

Discussion

The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk.

Conclusions

The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.

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References

  1. US Census Bureau (2012) 2012 National Population Projections: Summary Tables. Table 2. Projections of the population by selected age groups and sex for the United States: 2015–2060

  2. Tal S, Guller V, Shavit Y et al (2011) Mortality predictors in hospitalized elderly patients. QJM 104:933–938

    Article  CAS  PubMed  Google Scholar 

  3. Rubio-Rivas M, Formiga F, Grillo S et al (2015) Lymphopenia as prognostic factor for mortality and hospital length of stay for elderly hospitalized patients. Aging Clin Exp Res. doi:10.1007/s40520-015-0474-5

  4. Carey EC, Covinsky KE, Lui L-Y et al (2008) Predictors of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56:68–75

    Article  PubMed  Google Scholar 

  5. Bernabeu-Wittel M, Ollero-Baturone M, Moreno-Gaviño L et al (2011) Development of a new predictive model for polypathological patients. The PROFUND index. Eur J Intern Med 22:311–317

    Article  CAS  PubMed  Google Scholar 

  6. Rubenstein LZ (1998) Multidimensional Geriatric Assessment. In: Tallis RCF, Fillit HM, Brocklehurst JC (eds) Brocklehurst’s textbook of geriatric medicine and gerontology, 5th edn. Churchill Livingstone, London, pp 207–216

    Google Scholar 

  7. Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727

    Article  CAS  PubMed  Google Scholar 

  8. Lawton MP, Brody EM (1969) Assessment of older people: self- maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  PubMed  Google Scholar 

  9. Folstein MF, Folstein SE, McHugh PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  10. Yesavage JA, Brink TL, Rose TL et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49

    Article  PubMed  Google Scholar 

  11. Luis CA, Keegan AP, Mullan M (2009) Cross validation of the montreal cognitive assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 24:197–201

    Article  PubMed  Google Scholar 

  12. Rubenstein LZ, Harker JO, Salvà A et al (2001) Screening for undernutrition in geriatric practice: developing the Short-form mini-nutritional assessment. J Gerontol A Biol Sci Med Sci 56:366–372

    Article  Google Scholar 

  13. Kaiser MJ, Bauer JM, Ramsch C et al (2009) Validation of the mini nutritional assessment short-form: a practical tool for identification of nutritional status. J Nutr Health Aging 13:782

    Article  CAS  PubMed  Google Scholar 

  14. Sarikaya D, Halil M, Kuyumcu ME et al (2015) Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 61:56–60

    Article  PubMed  Google Scholar 

  15. Keskinoglu P, Ucku R, Yener G et al (2009) Reliability and validity of revised Turkish version of mini mental state examination (rMMSE-T) in community-dwelling educated and uneducated elderly. Int J Geriatr Psychiatry 24:1242–1250

    Article  PubMed  Google Scholar 

  16. Arik G, Varan HD, Yavuz BB et al (2015) Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr 61:344–350

    Article  PubMed  Google Scholar 

  17. Grundy SM, Cleeman JI, Daniels SR et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752

    Article  PubMed  Google Scholar 

  18. Lemeshow S, Hosmer Jr DW (1982) A review of goodness of fit statistic for use in the development of logistic regression models. Am J Epidemiol 115:92–106

    Article  CAS  PubMed  Google Scholar 

  19. Raggi P, Gongora MC, Gopal A et al (2008) Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 52:17–23

    Article  PubMed  Google Scholar 

  20. Gellert C, Schöttker B, Brenner H (2012) Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med 172:837–844

    Article  PubMed  Google Scholar 

  21. Park CH, Lee CW, Ko BS (2002) Relation of lifestyle variable to total mortality in a cohort of old residents aged 60–64 in a rural community. J Korean Acad Fam Med 23:1219–1228

    Google Scholar 

  22. Menotti A, Mulder I, Nissinen A et al (2001) Cardiovascular risk factors and 10 year all-cause mortality in elderly European male populations. Eur Heart J 22:573–579

    Article  CAS  PubMed  Google Scholar 

  23. Burns DM (2000) Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promot 14:357–361

    Article  CAS  PubMed  Google Scholar 

  24. Hunt KJ, Resendez RG, Williams K et al (2004) National cholesterol education program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation 110:1251–1257

    Article  PubMed  Google Scholar 

  25. Dominguez LJ, Barbagallo M (2007) The cardiometabolic syndrome and sarcopenic obesity in older persons. J Cardio Metab Syndr. 2:183–189

    Article  Google Scholar 

  26. Ravaglia G, Forti P, Maioli F et al (2006) Metabolic syndrome. Prevalence and prediction of mortality in elderly individuals. Diabetes Care 29:2471–2476

    Article  CAS  PubMed  Google Scholar 

  27. Butler J, Rodondi N, Zhu Y et al (2006) Metabolic syndrome and the risk of cardiovascular disease in older adults. J Am Coll Cardiol 47:1595–1602

    Article  PubMed  Google Scholar 

  28. Wang J, Ruotsalainen S, Moilanen L et al (2007) The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns. Eur Heart J 28:857–864

    Article  PubMed  Google Scholar 

  29. Zambon S, Zanoni S, Romanato G et al (2009) Metabolic syndrome and all-cause and cardiovascular mortality in an Italian elderly population: the Progetto Veneto Anziani (Pro.V.A.) Study. Diabetes Care 32:153–159

    Article  PubMed  PubMed Central  Google Scholar 

  30. Fuller JH, Shipley MJ, Rose G et al (1980) Coronary heart disease risk and impaired glucose tolerance: the Whitehall Study. Lancet 1:1373–1376

    Article  CAS  PubMed  Google Scholar 

  31. Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies: prospective studies collaboration. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  32. Miller GJ, Miller NE (1975) Plasma high density lipoprotein concentration and development of ischemic heart disease. Lancet 1:16–19

    Article  CAS  PubMed  Google Scholar 

  33. Lippel K, Tyroler H, Eder H et al (1981) Relationship of hypertriglyceridemia to atherosclerosis. Atherosclerosis 1:406–417

    CAS  Google Scholar 

  34. Grabowski DC, Ellis JE (2001) High body mass index does not predict mortality in older people: analysis of the longitudinal study of aging. J Am Geriatr Soc 49:968–979

    Article  CAS  PubMed  Google Scholar 

  35. Wallace JI, Schwartz RS, LaCroix AZ et al (1995) Involuntary weight loss in older outpatients: incidence and clinical significance. J Am Geriatr Soc 43:329–337

    Article  CAS  PubMed  Google Scholar 

  36. Wannamethee SG, Shaper AG, Lennon L (2005) Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med 165:1035–1040

    Article  PubMed  Google Scholar 

  37. Pednekar MS, Gupta PC, Hebert JR et al (2008) Joint effects of tobacco use and body mass on all-cause mortality in Mumbai, India: results from a population-based cohort study. Am J Epidemiol 167:330–340

    Article  PubMed  Google Scholar 

  38. Naseer M, Forssell H, Fagerström C (2016) Malnutrition, functional ability and mortality among older people aged ≥ 60 years: a 7-year longitudinal study. Eur J Clin Nutr 70(3):399–404. doi:10.1038/ejcn.2015.196

  39. Newman AB, Yanez D, Harris T et al (2001) Weight change in old age and its association with mortality. J Am Geriatr Soc 49:1309–1318

    Article  CAS  PubMed  Google Scholar 

  40. Iglesias P, Muñoz A, Prado F et al (2009) Alterations in thyroid function tests in aged hospitalized patients: prevalence, aetiology and clinical outcome. Clin Endocrinol 70:961–967

    Article  CAS  Google Scholar 

  41. De Alfieri W, Nisticò F, Borgogni T et al (2013) Thyroid hormones as predictors of short- and long-term mortality in very old hospitalized patients. J Gerontol Ser A Biol Sci Med Sci 68:1122–1128

    Article  Google Scholar 

  42. Fontana L, Addante F, Copetti M et al (2013) Identification of a metabolic signature for multidimensional impairment and mortality risk in hospitalized older patients. Aging Cell 12:459–466

    Article  CAS  PubMed  Google Scholar 

  43. Wang F, Pan W, Wang H et al (2012) Relationship between thyroid function and ICU mortality: a prospective observation study. Crit Care 16:R11

    Article  PubMed  PubMed Central  Google Scholar 

  44. Van Den Beld AW, Visser TJ, Feelders RA et al (2005) Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J Clin Endocrinol Metab 90:6403–6409

    Article  PubMed  Google Scholar 

  45. Simons RJ, Simon JM, Demers LM et al (1990) Thyroid dysfunction in elderly hospitalized patients. Effect of age and severity of illness. Arch Intern Med 150:1249–1253

    Article  CAS  PubMed  Google Scholar 

  46. Bossoni S, Cossi S, Marengoni A et al (2002) Low T3 syndrome and outcome in elderly hospitalized geriatric patients. J Endocrinol Invest 25:73–74

    Article  CAS  PubMed  Google Scholar 

  47. Tognini S, Marchini F, Dardano A et al (2010) Non-thyroidal illness syndrome and short-term survival in a hospitalized older population. Age Ageing 39:46–50

    Article  PubMed  Google Scholar 

  48. Keller BK, Potter JF (1994) Predictors of mortality in outpatient geriatric evaluation and management clinic patients. J Gerontol 49:M246–M251

    Article  CAS  PubMed  Google Scholar 

  49. Ganguli M, Dodge HH, Mulsant BH (2002) Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. Arch Gen Psychiatry 59:1046–1052

    Article  PubMed  Google Scholar 

  50. Dewey ME, Saz P (2001) Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatric Psychiatry 16:751–761

    Article  CAS  Google Scholar 

  51. Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 40:922–935 (Review)

    Article  CAS  PubMed  Google Scholar 

  52. Tozlu M, Cankurtaran M, Yavuz BB et al (2014) Functional disability in Alzheimer disease: a validation study of the Turkish version of the disability assessment for dementia scale. J Geriatr Psychiatry Neurol 27(4):237–246

    Article  PubMed  Google Scholar 

  53. Jagger C, Clarke M, Stone A (1995) Predictors of survival with Alzheimer’s disease: a community-based study. Psychol Med 25:171–177

    Article  CAS  PubMed  Google Scholar 

  54. Heyman A, Peterson B, Fillenbaum G et al (1996) The consortium to establish a registry for Alzheimer’s disease (CERAD). Part XIV: demographic and clinical predictors of survival in patients with Alzheimer disease. Neurology 46:656–660

    Article  CAS  PubMed  Google Scholar 

  55. Lane D, Carroll D, Ring C et al (2002) In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction. Int J Epidemiol 31:1179–1182

    Article  PubMed  Google Scholar 

  56. Hacihasanoğlu R, Yildirim A, Karakurt P (2012) Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors. Arch Gerontol Geriatr 54:61–66

    Article  PubMed  Google Scholar 

  57. Tognini S, Marchini F, Dardano A et al (2010) Non-thyroidal illness syndrome and short-term survival in a hospitalized older population. Age Ageing 39:46–50

    Article  PubMed  Google Scholar 

  58. Haveman-Nies A, de Groot LP, Burema J et al (2002) Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study. Am J Epidemiol 156:962–968

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Ozgur Kara, Busra Canbaz, Muhammet Cemal Kizilarslanoglu, Gunes Arik, Fatih Sumer, Gozde Sengul Aycicek, Hacer Dogan Varan, Mustafa Kemal Kilic, Rana Tuna Dogru, Mehmet Emin Kuyumcu, Yusuf Yesil, Burcu Balam Yavuz, Meltem Halil & Mustafa Cankurtaran

  2. Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Medical School, Ankara, Turkey

    Zekeriya Ulger

  3. Division of Geriatric Medicine, Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey

    Esat Cınar

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  1. Ozgur Kara
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Correspondence to Busra Canbaz.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kara, O., Canbaz, B., Kizilarslanoglu, M.C. et al. Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?. Aging Clin Exp Res 29, 509–515 (2017). https://doi.org/10.1007/s40520-016-0574-x

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