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Wakerly ZR, Soiza RL, Pana TA, Myint PK. Does Estimated Glomerular Filtration Rate Predict In-Hospital Mortality in Acutely Unwell Hospitalized Oldest Old? Geriatrics (Basel) 2022; 7:geriatrics7060135. [PMID: 36547271 PMCID: PMC9777760 DOI: 10.3390/geriatrics7060135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Globally the population of older adults is the fastest growing age group. Estimated glomerular filtration rate (eGFR) is an estimation of true kidney function with lower eGFR associated with higher mortality. However, few studies explore eGFR's prognostic value in the nonagenarian. We investigated the association between eGFR on admission and mortality among the nonagenarians hospitalised with acute illness. A retrospective analysis of a prospective cohort study included patients aged ≥ 90 admitted into three acute medical assessment units or acute geriatric wards in England and Scotland between November 2008 and January 2009. Association between eGFR and all-cause mortality was evaluated using the Cox proportional hazard models controlling for potential confounders including frailty. 392 patients with mean (SD) 93.0 ± 2.6 years (68.45% women) were included. The median (IQR) eGFR was 26.61 (18.41-40.41) mL/min/1.732. 63 died in in hospital. Low eGFR was not associated with mortality (Hazard ratio (HR) 1.00 (95% CI 0.98-1.02) overall or in sub-group analysis by frailty (HR 0.96 (0.92-1.01)) or by eGFR of ≤30 (HR 1.01 (0.95-1.06). We found no evidence of prognostic value of eGFR in predicting in-hospital mortality in the acutely unwell hospitalised nonagenarians.
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Affiliation(s)
- Zack Robert Wakerly
- Ageing Clinical & Experimental Research Team (ACER), Institute of Applied health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Correspondence:
| | - Roy L. Soiza
- Ageing Clinical & Experimental Research Team (ACER), Institute of Applied health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Aberdeen Royal Infirmary, National Health Service Grampian, Aberdeen AB25 2ZN, UK
| | - Tiberiu A. Pana
- Ageing Clinical & Experimental Research Team (ACER), Institute of Applied health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Aberdeen Royal Infirmary, National Health Service Grampian, Aberdeen AB25 2ZN, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research Team (ACER), Institute of Applied health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Aberdeen Royal Infirmary, National Health Service Grampian, Aberdeen AB25 2ZN, UK
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Soley-Bori M, Ashworth M, Bisquera A, Dodhia H, Lynch R, Wang Y, Fox-Rushby J. Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature. Br J Gen Pract 2021; 71:e39-e46. [PMID: 33257463 PMCID: PMC7716874 DOI: 10.3399/bjgp20x713897] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK. AIM To assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components. DESIGN AND SETTING A systematic review. METHOD This systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible. RESULTS Seventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity. CONCLUSION In the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.
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Affiliation(s)
| | - Mark Ashworth
- King's College London, School of Population Health Sciences, London
| | | | - Hiten Dodhia
- King's College London, School of Population Health Sciences, London
| | - Rebecca Lynch
- King's College London, School of Population Health Sciences, London
| | - Yanzhong Wang
- King's College London, School of Population Health Sciences, London
| | - Julia Fox-Rushby
- King's College London, School of Population Health Sciences, London
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Talmage CA, Coon DW, Dugger BN, Knopf RC, O’Connor KA, Schofield SA. Social Leisure Activity, Physical Activity, and Valuation of Life: Findings from a Longevity Study. ACTIVITIES ADAPTATION & AGING 2019. [DOI: 10.1080/01924788.2019.1581026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Craig A. Talmage
- Entrepreneurial Studies Department, Hobart & William Smith Colleges, Geneva, NY, USA
| | - David W. Coon
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Brittany N. Dugger
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, USA
| | - Richard C. Knopf
- School of Community Resources and Development, Watts College of Public Service and Community Solutions
| | - Kathy A. O’Connor
- Longevity Study - Center for Health Aging, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Sharon A. Schofield
- Longevity Study - Center for Health Aging, Banner Sun Health Research Institute, Sun City, AZ, USA
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Validación externa de la regla NaURSE para predecir mortalidad intrahospitalaria en nonagenarios. Rev Clin Esp 2018; 218:110-111. [DOI: 10.1016/j.rce.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/20/2022]
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Validation of the NaURSE rule for predicting in-hospital mortality in nonagenarians. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wilson AH, Kidd AC, Skinner J, Musonda P, Pai Y, Lunt CJ, Butchart C, Soiza RL, Potter JF, Myint PK. A simple 5-point scoring system, NaURSE (Na+, urea, respiratory rate and shock index in the elderly), predicts in-hospital mortality in oldest old. Age Ageing 2014; 43:352-7. [PMID: 24487652 DOI: 10.1093/ageing/afu002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.
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Affiliation(s)
- Alexander H Wilson
- Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK
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Kidd AC, Musonda P, Soiza RL, Butchart C, Lunt CJ, Pai Y, Hameed Y, Fox C, Potter JF, Myint PK. The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. Arch Gerontol Geriatr 2014; 59:155-61. [PMID: 24582945 DOI: 10.1016/j.archger.2014.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.
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Affiliation(s)
- Andrew C Kidd
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island.
| | - Patrick Musonda
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island
| | - Roy L Soiza
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Catherine Butchart
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom
| | - Claire J Lunt
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom
| | - Yogish Pai
- University Hospital of South Manchester, Manchester M23 9LT, United Kingdom
| | - Yasir Hameed
- Norfolk & Waveney Mental Health Care Trust, Norwich NR6 5BE, United Kingdom
| | - Chris Fox
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island
| | - John F Potter
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island
| | - Phyo Kyaw Myint
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom.
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Butchart C, Ismailoglu F, Myint PK, Musonda P, Lunt CJ, Pai Y, Soiza RL, Rayward-Smith V. Identification of possible determinants of inpatient mortality using Classification and Regression Tree (CART) analysis in hospitalized oldest old patients. Arch Gerontol Geriatr 2013; 56:188-91. [DOI: 10.1016/j.archger.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 07/13/2012] [Accepted: 07/14/2012] [Indexed: 11/26/2022]
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