Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study

ObjectivesTo estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients.DesignMulticentre, prospective cohort study.SettingInternal medicine or geriatric services of five general teaching hospitals in Spain.Participants740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018.Primary and secondary outcome measuresActive chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team.Results740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters.ConclusionsIn older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients.Trial registration numberNCT02830425.

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“Thank You for Giving Me a Voice!” A Longitudinal Evaluation of Patients’ Experience of Partnering With Students in an Australian Medical School

Journal of Medical Education and Curricular Development ◽

10.1177/2382120517692776 ◽

2017 ◽

Vol 4 ◽

pp. 238212051769277 ◽

Cited By ~ 3

Author(s):

Kimberley Dale Ivory ◽

Georgina Luscombe ◽

Linda Ann Klein ◽

Alexandra Barratt

Keyword(s):

Medical Education ◽

Cohort Study ◽

Chronic Disease ◽

Medical Students ◽

Medical School ◽

Lived Experience ◽

Chronic Conditions ◽

Baseline Survey ◽

Illness Experiences ◽

Patients Experience

Background: We evaluated the patient-partner experience in a longitudinal program called Integrated Population Medicine in the Sydney Medical School to assess its acceptability. The program exposed senior medical students to the lived experience of chronic disease. Methods: We surveyed 267 people with chronic conditions recruited as patient-partners by the 2012 student cohort in a mixed-methods longitudinal cohort study. Surveys were administered ‘over’ 18 months: before, during, and after the program. Results: A total of 155 (58%) patient-partners completed the baseline survey; 52 patients returned all 3 surveys. Patient-partners remained very positive about the program across all surveys. More than 95% of respondents enjoyed interacting with the student, and most were very positive about their role in teaching the student. Three major themes emerged: willingness to help, a sense of gratitude and enjoyment, and a chance to teach and learn. Participants were willing to discuss their illness experiences and were keen to spend more time with students. Conclusions: Patients are willing participants in longitudinal patient-partner programs. They perceive benefits for themselves and others, for the health system, and for students and would like to become more actively involved in medical education.

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Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02715-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Marisa Baré ◽

Marina Lleal ◽

Sara Ortonobes ◽

Maria Queralt Gorgas ◽

Daniel Sevilla-Sánchez ◽

...

Keyword(s):

Cohort Study ◽

Chronic Disease ◽

Medication Review ◽

Older Patients ◽

Primary Outcome ◽

Inappropriate Prescribing ◽

Potentially Inappropriate Prescribing ◽

Disease Exacerbation ◽

Factors Associated ◽

Start Criteria

Abstract Objectives The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). Methods A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. Results A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. Conclusions PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. Trial registration number NCT02830425

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The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

BMC Medicine ◽

10.1186/s12916-020-01761-0 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Yao Ma ◽

Lisha Hou ◽

Xiufang Yang ◽

Zhixin Huang ◽

Xue Yang ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Older Patients ◽

Poor Prognosis ◽

Severe Disease ◽

White Blood Count ◽

Severe Illness ◽

Geriatric Syndrome ◽

Frail Patients

Abstract Background The coronavirus disease 2019 (COVID-19) has been a pandemic worldwide. Old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, whether frailty, a common geriatric syndrome of reduced reserve to stressors, is associated with poor prognosis among older COVID-19 patients is unknown. The aim of our study is to investigate the association between frailty and severe disease among COVID-19 patients aged ≥ 60 years. Methods A prospective cohort study of 114 hospitalized older patients (≥ 60 years) with confirmed COVID-19 pneumonia was conducted between 7 February 2020 and 6 April 2020. Epidemiological, demographic, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. All patients were assessed for frailty on admission using the FRAIL scale, in which five components are included: fatigue, resistance, ambulation, illnesses, and loss of weight. The outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards models to identify the unadjusted and adjusted associations between frailty and severe illness. The significant variables in univariable analysis were included in the adjusted model. Results Of 114 patients, (median age, 67 years; interquartile range = 64–75 years; 57 [50%] men), 39 (34.2%), 39 (34.2%), and 36 (31.6%) were non-frail, pre-frail, and frail, respectively. During the 60 days of follow-up, 43 severe diseases occurred including eight deaths. Four of 39 (10.3%) non-frail patients, 15 of 39 (38.5%) pre-frail patients, and 24 of 36 (66.7%) frail patients progressed to severe disease. After adjustment of age, sex, body mass index, haemoglobin, white blood count, lymphocyte count, albumin, CD8+ count, D-dimer, and C-reactive protein, frailty (HR = 7.47, 95% CI 1.73–32.34, P = 0.007) and pre-frailty (HR = 5.01, 95% CI 1.16–21.61, P = 0.03) were associated with a higher hazard of severe disease than the non-frail. Conclusions Frailty, assessed by the FRAIL scale, was associated with a higher risk of developing severe disease among older COVID-19 patients. Our findings suggested that the use of a clinician friendly assessment of frailty could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.

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Conceptualizing geriatric syndromes

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0048 ◽

2017 ◽

pp. 355-362 ◽

Cited By ~ 1

Author(s):

Marcel G. M. Olde Rikkert

Keyword(s):

Older Patients ◽

Main Part ◽

Preliminary Evidence ◽

Geriatric Syndrome ◽

Geriatric Syndromes ◽

Warning Signals ◽

Slowing Down ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

Geriatric syndromes, such as falling, delirium, and malnutrition, are common in older patients, and characterized by the presence of several disorders at the same time. These geriatric syndromes can be divided into acute (e.g. delirium) and non-acute (e.g. dizziness, falls) geriatric syndromes. The main criterion of multicausality is directly linked to frailty in older patients, as frailty results in a closer linkage and increased interaction between organ functions, which explains why several organs, diseases, and stressors are involved in each geriatric syndrome. There is interesting preliminary evidence for the existence of generic warning signals for the recurrence of acute geriatric syndromes, of which the most important is slowing down of recovery after a perturbation of the organ functions involved in a geriatric syndrome. All these pathophysiological mechanisms have important implications for diagnostic work up and treatment of geriatric syndromes, which together makes up the main part of geriatric patient care.

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The role of SARC-F scale in predicting progression risk of COVID-19 in elderly patients: a prospective cohort study in Wuhan

BMC Geriatrics ◽

10.1186/s12877-021-02310-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yao Ma ◽

Min He ◽

Li-Sha Hou ◽

Shen Xu ◽

Zhi-Xin Huang ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Older Patients ◽

Poor Prognosis ◽

Severe Disease ◽

Laboratory Data ◽

Geriatric Syndrome ◽

Severe Condition

Abstract Background Since the outbreak of COVID-19, it has been documented that old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, it is unknown whether sarcopenia, a common geriatric syndrome, is associated with poor prognosis among older COVID-19 patients. The aim of our prospective cohort study is to investigate the association between sarcopenia risk and severe disease among COVID-19 patients aged ≥60 years. Method A prospective cohort study of 114 hospitalized older patients (≥60 years) with confirmed COVID-19 pneumonia between 7 February, 2020 and 6 April, 2020. Epidemiological, socio-demographic, clinical and laboratory data on admission and outcome data were extracted from electronic medical records. All patients were assessed for sarcopenia on admission using the SARC-F scale and the outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards model to identify the association between sarcopenia and progression of disease defined as severe cases in a total of 2908 person-days. Result Of 114 patients (mean age 69.52 ± 7.25 years, 50% woman), 38 (33%) had a high risk of sarcopenia while 76 (67%) did not. We found that 43 (38%) patients progressed to severe cases. COVID-19 patients with higher risk sarcopenia were more likely to develop severe disease than those without (68% versus 22%, p < 0.001). After adjustment for demographic and clinical factors, higher risk sarcopenia was associated with a higher hazard of severe condition [hazard ratio = 2.87 (95% CI, 1.33–6.16)]. Conclusion We found that COVID-19 patients with higher sarcopenia risk were more likely to develop severe condition. A clinician-friendly assessment of sarcopenia could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.

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