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Steinman MA, Jing B, Shah SJ, Rizzo A, Lee SJ, Covinsky KE, Ritchie CS, Boscardin WJ. Development and validation of novel multimorbidity indices for older adults. J Am Geriatr Soc 2023; 71:121-135. [PMID: 36282202 PMCID: PMC9870862 DOI: 10.1111/jgs.18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes. METHODS Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study. RESULTS The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts. CONCLUSIONS A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.
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Affiliation(s)
- Michael A. Steinman
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Bocheng Jing
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Sachin J. Shah
- Division of Hospital Medicine, UCSF, San Francisco, California, USA
| | - Anael Rizzo
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- David Geffen School of Medicine at UCLA, San Francisco, California, USA
| | - Sei J. Lee
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Kenneth E. Covinsky
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and the Mongan Institute Center for Aging and Serious Illness, Boston, MA, USA
| | - W. John Boscardin
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
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Liquori G, De Leo A, De Nuzzo D, D’Inzeo V, Arancio RM, Di Simone E, Dionisi S, Giannetta N, Ricciardi F, Fabbian F, Orsi GB, Di Muzio M, Napoli C. Management Strategies and Nursing Activities for Nutritional Care in Hospitalized Patients with Cognitive Decline: A Scoping Review. Nutrients 2022; 14:nu14194036. [PMID: 36235687 PMCID: PMC9573259 DOI: 10.3390/nu14194036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment and dementia can negatively impact the nutritional capacities of older people. Malnutrition is common in hospitalized frail elderly people with cognitive impairment and negatively affects prognosis. Malnutrition worsens the quality of life and increases morbidity and mortality. This scoping review aimed to identify factors affecting the risk of malnutrition and preventive strategies in hospitalized patients with cognitive impairment, focusing on nursing interventions. The authors researched population, context, and concept in international databases of nursing interest. Full texts that met the inclusion criteria were selected and reviewed. The extracted data were subject to thematic analysis. A five-stage approach, already reported in the scientific literature, was utilized in the following scoping review. Of 638 articles yielded, 9 were included. Two focus areas were identified as follows: (1) prevalence and risk factors of malnutrition in older patients with cognitive decline; (2) nursing strategies used to enhance clinical outcomes. Nursing health interventions aim to recognize and reduce malnutrition risk, positively impacting this phenomenon. A multidisciplinary team is essential to meet the nutritional needs of these patients.
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Affiliation(s)
- Gloria Liquori
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Aurora De Leo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
- Nursing, Technical, Rehabilitation, Assistance and Research Direction—IRCCS Istituti Fisioterapici Ospitalieri—IFO, 00144 Rome, Italy
| | - Daniele De Nuzzo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Victoria D’Inzeo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Rosario Marco Arancio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction—IRCCS Istituti Fisioterapici Ospitalieri—IFO, 00144 Rome, Italy
| | - Sara Dionisi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Ricciardi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Christian Napoli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-3377-5529
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De Giorgi A, Storari A, Rodríguez-Muñoz PM, Cappadona R, Lamberti N, Manfredini F, López-Soto PJ, Manfredini R, Fabbian F. Seasonal pattern in elderly hospitalized with acute kidney injury: a retrospective nationwide study in Italy. Int Urol Nephrol 2022; 54:3243-3253. [PMID: 35779158 PMCID: PMC9605924 DOI: 10.1007/s11255-022-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
Purpose Acute kidney injury (AKI) frequently complicates hospitalization and is associated with in-hospital mortality (IHM). It has been reported a seasonal trend in different clinical conditions. The aim of this study was to evaluate the possible relationship between seasons of the year and IHM in elderly hospitalized patients with AKI. Methods We selected all admissions complicated by AKI between 2000 and 2015 recorded in the Italian National Hospital Database. ICD-9-CM code 584.xx identified subjects with age ≥ 65 years and age, sex, comorbidity burden, need of dialysis treatment and IHM were compared in hospitalizations recorded during the four seasons. Moreover, we plotted the AKI observed/expected ratio and percentage of mortality during the study period. Results We evaluated 759,720 AKI hospitalizations (mean age 80.5 ± 7.8 years, 52.2% males). Patients hospitalized with AKI during winter months had higher age, prevalence of dialysis-dependent AKI, and number of deceased patients. In whole population IHM was higher in winter and lower in summer, while the AKI observed/expected ratio demonstrated two peaks, one in summer and one in winter. Logistic regression analysis demonstrated that parameters such as age, autumn, winter, comorbidity burden were positively associated with IHM. Conclusion We conclude that a seasonality exists in AKI, however, relationship between seasons and AKI could vary depending on the aspects considered. Both autumn and winter months are independent risk factors for IHM in patients with AKI regardless of age, sex and comorbidity burden. On the contrary, summer time reduces the risk of death during hospitalizations with AKI.
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Affiliation(s)
| | - Alda Storari
- Nephrology and Dialysis Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Pedro Manuel Rodríguez-Muñoz
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain.,Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Rosaria Cappadona
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Pablo Jesús López-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain.,Department of Nursing, Universidad de Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Roberto Manfredini
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals? J Geriatr Cardiol 2022; 19:254-264. [PMID: 35572223 PMCID: PMC9068589 DOI: 10.11909/j.issn.1671-5411.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047-3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161-1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.
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De Giorgi A, Fabbian F, Cappadona R, Tiseo R, Molino C, Misurati E, Gambuti E, Savriè C, Boari B, Raparelli V, Manfredini R. Do Sex-Related Differences of Comorbidity Burden and/or In-Hospital Mortality Exist in Cancer Patients? A Retrospective Study in an Internal Medicine Setting. Life (Basel) 2021; 11:261. [PMID: 33810124 PMCID: PMC8004908 DOI: 10.3390/life11030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022] Open
Abstract
Cancer represents important comorbidity, and data on outcomes are usually derived from selected oncologic units. Our aim was to evaluate possible sex-related differences and factors associated with in-hospital mortality (IHM) in a consecutive cohort of elderly patients with cancer admitted to internal medicine. We included all patients admitted to our department with a diagnosis of cancer during 2018. Based on the International Classification of Diseases, 9th Revision, Clinical Modification, demography, comorbidity burden, and diagnostic procedures were evaluated, with IHM as our outcome. We evaluated 955 subjects with cancer (23.9% of total hospital admissions), 42.9% were males, and the mean age was 76.4 ± 11.4 years. Metastatic cancer was diagnosed in 18.2%. The deceased group had a higher modified Elixhauser Index (17.6 ± 7.7 vs. 14 ± 7.3, p < 0.001), prevalence of cachexia (17.9% vs. 7.2%, p < 0.001), and presence of metastasis (27.8% vs. 16.3%, p = 0.001) than survivors. Females had a higher age (77.4 ± 11.4 vs. 75.5 ± 11.4, p = 0.013), and lower comorbidity (10.2 ± 5.9 vs. 12.0 ± 5.6, p < 0.001) than males. IHM was not significantly different among sex groups, but it was independently associated with cachexia and metastasis only in women. Comorbidities are highly prevalent in patients with cancer admitted to the internal medicine setting and are associated with an increased risk of all-cause mortality, especially in female elderly patients with advanced disease.
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Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Fabio Fabbian
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Ruana Tiseo
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Christian Molino
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Elisa Misurati
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Edoardo Gambuti
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Caterina Savriè
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Benedetta Boari
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Roberto Manfredini
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
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