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Frailty degree and illness trajectories in older people towards the end-of-life:a prospective observational study
- Source :
- Amblàs-Novellas, J, Murray, S A, Oller, R, Torné, A, Martori, J C, Moine, S, Latorre-Vallbona, N, Espaulella, J, Santaeugènia, S J & Gómez-Batiste, X 2021, ' Frailty degree and illness trajectories in older people towards the end-of-life : a prospective observational study ', BMJ Open, vol. 11, no. 4, pp. e042645 . https://doi.org/10.1136/bmjopen-2020-042645, BMJ Open, BMJ Open, Vol 11, Iss 4 (2021)
- Publication Year :
- 2021
-
Abstract
- ObjectivesTo assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.MethodsProspective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.ResultsOf the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (pConclusionsAll older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.
- Subjects :
- medicine.medical_specialty
Palliative care
Frail Elderly
Degree (temperature)
adult palliative care
quality in health care
03 medical and health sciences
0302 clinical medicine
medicine
Dementia
Humans
030212 general & internal medicine
Prospective Studies
Geriatric Assessment
Survival analysis
Aged
Geriatrics
Aged, 80 and over
Receiver operating characteristic
Frailty
Proportional hazards model
business.industry
geriatric medicine
Palliative Care
General Medicine
medicine.disease
Death
Spain
Medicine
Observational study
business
030217 neurology & neurosurgery
Demography
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Amblàs-Novellas, J, Murray, S A, Oller, R, Torné, A, Martori, J C, Moine, S, Latorre-Vallbona, N, Espaulella, J, Santaeugènia, S J & Gómez-Batiste, X 2021, ' Frailty degree and illness trajectories in older people towards the end-of-life : a prospective observational study ', BMJ Open, vol. 11, no. 4, pp. e042645 . https://doi.org/10.1136/bmjopen-2020-042645, BMJ Open, BMJ Open, Vol 11, Iss 4 (2021)
- Accession number :
- edsair.doi.dedup.....a1b78e57cd177691907942647f6e35e8