Abstract
Assessment of overall physical health is an important yet little studied problem in geriatric research. The Cumulative Illness Rating Scale (CIRS) was among the first instruments that attempted to summarize the overall severity of illness based on clinical information. This study evaluated the CIRS in a prospective longitudinal study of 181 elderly (mean age ± SD = 79 ± 7.4) subjects undergoing comprehensive geriatric assessment in an outpatient unit. The CIRS was found to correlate negatively with activities of daily living (@#@ r = − 0.49, p = 0.0001), instrumental activities of daily living (@#@ r = − 0.34, p = 0.0001), patient morale (@#@ r = − 0.30, p = 0.0001), and positively with days in hospital (@#@ r = 0.21, p = 0.0075) and number of medications (@#@ r = 0.31, p = 0.0001). Mean CIRS scores for subjects who died during follow- up were significantly higher than the scores for survivors (@#@ p<0.01 @#@). In logistic regression, CIRS was a significant predictor of death, yet it did not improve that prediction over information contained in measures of activities of daily living. In separate logistic analyses, CIRS and age predicted acute care hospital days during follow- up, while ADL or IADL predicted the use of nursing home services. Although the CIRS appears to be a reliable method of summarizing medical information and to have some external validity, in its present form it does not provide additional prognostic information. (Aging Clin. Exp. Res. 4: 171- 178, 1992)
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References
Kane R.A., Kane R.L.: Measures of physical functioning in long-term care. In: Kane R.A., Kane R.L. (Eds.), Assessing the Elderly: A Practical Guide to Measurement. Lexington Books, Lexington and Toronto, 1981, pp. 25–67.
Brodman K., Erdman A.J., Longe I., Wolff H.G.: The Cornell medical index health questionnaire: II. as a diagnostic instrument. JAMA 145: 152–157, 1951.
Rosencramz H.A., Pihlblad C.T.: Measuring the health of the elderly. J. Gerontol. 25: 129–133, 1970.
Duke University Center for the Study of Aging and Human Development: Multidimensional Functional Assessment: The OARS Methodology. Duke University, Durham, N.C., 1978.
Kaplan M.H., Feinstein A.R.: The importance of classifying initial comorbidity in evaluating the outcome of Diabetes Mellitus. J. Chronic Dis. 27: 387–404, 1974.
Greenfield S., Blanco D.M., Elashoff R.M., Ganz P.A.: Patterns of care related to age of breast cancer patients. JAMA 257: 2766–2770, 1987.
Charlson M.E., Sax F.L., Mackenzie C.R., Fields S.D., Braham R.L., Douglas R.G.: Assessing illness severity: Does clinical judgment work? J. Chronic Dis. 39: 439–452, 1986.
Charlson M.E., Pompei P., Ales K.L., Mackenzie C.R.: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 40: 373–383, 1987.
Pompei P., Charlson M.E., Douglas G.: Clinical assessments as predictors of one year survival after hospitalization. J. Clin. Epidemiol. 41: 275–284, 1988.
Stewart A.L., Greenfield S., Hays R.D., Wells K., Rogers W.H., Berry S.D., Mc Glynn E.A., Ware J.E.: Functional status and well-being of patients with chronic conditions. JAMA 262: 907–913, 1989.
Linn B.S., Linn M.W., Gurel L.: Cumulative illness rating scale. J. Am. Geriatr. Soc. 16: 622–626, 1968.
Linn B.S., Linn M.W.: Objective and self-assessed health in the old and very old. Soc. Sci. Med. 14: 311–315, 1980.
Lawton M., Brody E.M.: Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9: 179–186, 1969.
Morris J.N., Sherwood S.: A re-testing and modification of the Philadelphia Geriatric Center Morale Scale. J. Gerontol. 30: 77–84, 1975.
Williams M.E.: Outpatient geriatric evaluation. Geriatr. Clin. 3: 175–183, 1987.
Williams M.E.: Identifying the older person likely to require long-term care services. J. Am. Geriatr. Soc. 35: 761–766, 1987.
Scholer S.G., Potter J.F., Burke W.J.: Does the Williams Manual Test Predict Service Use Among Subjects Undergoing Geriatric Assessment? J. Am. Geriatr. Soc. 38: 767–772, 1990.
Walker S., Duncan D.: Estimation of the probability of an event as a function of several independent variables. Biometrica 54: 167–169, 1967.
Aldrich J.N., Nelson F.D.: Linear probability, logit and probid models: Sage University paper series on quantitative applications in the social sciences, Series 07-045. Sage Publications, Beverly Hills and London, 1984, p. 55.
Knaus W.A., Draper E.A., Wagner D.P., Zimmerman J.E.: Apache II: A severity of disease classification system. Crit. Care Med. 13: 818–829, 1985.
Brown L.J., Potter J.F., Foster B.G.: Caregiver burden should be evaluated during geriatric assessment. J. Am. Geriatr. Soc. 38: 455–460, 1990.
Rubenstein L.Z., Josephson K.R., Wieland G.D., English P.A., Sayre J.A., Kane R.L.: Effectiveness of a geriatric evaluation unit: A randomized clinical trial. N. Engl. J. Med. 311: 1664–1670, 1984.
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The data reported in this paper were presented in part at a meeting of the Gerontological Society of America, San Francisco, California, U.S.A., November 1988.
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Waldman, E., Potter, J.F. A prospective evaluation of the cumulative illness rating scale. Aging Clin Exp Res 4, 171–178 (1992). https://doi.org/10.1007/BF03324087
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DOI: https://doi.org/10.1007/BF03324087