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A 10-min Targeted Geriatric Assessment Predicts Mortality in Fast-Paced Acute Care Settings: A Prospective Cohort Study

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To estimate whether a 10-minute Targeted Geriatric Assessment (10-TaGA) adds utility to sociodemographic characteristics and comorbidities in predicting one-year mortality in busy acute care settings. We have also compared the performance of 10-TaGA with the Identification of Seniors at Risk (ISAR) scale.

Design

Prospective cohort study.

Setting

Geriatric day hospital specializing in acute care in Brazil

Participants

751 older adults aged 79.4 ± 8.4 years (64% female), presenting non-surgical, medical illness requiring hospital-level care (e.g., intravenous therapy, laboratory test, radiology) for ≤ 12 hours.

Measurements

The 10-TaGA, an easy-to-administer screening tool based on the comprehensive geriatric assessment (CGA), provided a measure of cumulative deficits ranging from 0 (no deficits) to 1 (highest deficit) on admission. Standard risk factors, including sociodemographics (age, gender, ethnicity, income) and the Charlson comorbidity index, were evaluated. The ISAR, a well-validated screening tool, was used for comparison.

Results

During one year of follow-up, 130 (17%) participants died. Compared to the ISAR, 10-TaGA offered better accuracy in identifying older patients at risk of death (area under the receiver operating characteristic curve: [AUC] 0.70 vs 0.65; P = 0.03). In a Cox regression model adjusted for sociodemographics and comorbidities, each 0.1 increment in the 10-TaGA score (range 0–1) was associated with increased mortality (hazard ratio = 1.42, 95% confidence interval 1.27–1.59). The addition of 10-TaGA markedly improved the discrimination of the model, which already incorporated standard risk factors (AUC 0.76 vs 0.71; P = 0.005); adding ISAR (AUC 0.73 vs 0.71; P = 0.09) did not have this marked effect.

Conclusion

The 10-TaGA is an independent predictor of one-year mortality in acute care patients. This multidimensional screening tool offers better accuracy than ISAR when differentiating between older people at low and high risk of death in healthcare settings where providers have limited time and resources.

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Authors and Affiliations

  1. Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Márlon J. R. Aliberti, D. Apolinario, S. Q. Fortes-Filho, J. A. Melo, S. S. C. Viana, C. K. Suemoto & W. Jacob-Filho

  2. Division of Geriatrics, University of California, San Francisco (UCSF), San Francisco, California, USA

    Márlon J. R. Aliberti, K. E. Covinsky & S. J. Lee

  3. Veterans Affairs Medical Center, San Francisco, California, USA

    Márlon J. R. Aliberti, K. E. Covinsky & S. J. Lee

  4. Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, , Av. Dr. Eneas de Carvalho Aguiar 255 8º Andar, Bloco 8—Nucleo de Apoio a Pesquisa e Ensino em Geriatria e Gerontologia, Sao Paulo, SP, 05403-000, Brazil

    Márlon J. R. Aliberti

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  1. Márlon J. R. Aliberti
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  2. K. E. Covinsky
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  3. D. Apolinario
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  7. S. S. C. Viana
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Correspondence to Márlon J. R. Aliberti.

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Aliberti, M.J.R., Covinsky, K.E., Apolinario, D. et al. A 10-min Targeted Geriatric Assessment Predicts Mortality in Fast-Paced Acute Care Settings: A Prospective Cohort Study. J Nutr Health Aging 23, 286–290 (2019). https://doi.org/10.1007/s12603-018-1152-z

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  • DOI: https://doi.org/10.1007/s12603-018-1152-z

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