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M Dramé,
P O Lang,
J-L Novella,
D Narbey,
R Mahmoudi,
I Lanièce,
D Somme, J-B Gauvain,
D Heitz,
T Voisin,
B de Wazières,
R Gonthier,
J Ankri,
O Saint-Jean,
C Jeandel,
P Couturier,
F Blanchard,
D Jolly
[show abstract]
[hide abstract]
ABSTRACT: The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization.
A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period.
Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR=1.83; 95% CI=1.27-2.62) or a higher number of children (HR=0.86; 95% CI=0.78-0.96), balance problems (HR=1.72; 95% CI=1.19-2.47), malnutrition or risk thereof (HR=1.93; 95% CI=1.24-3.01), and dementia syndrome (HR=1.88; 95% CI=1.32-2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR=1.92; 95% CI=1.17-3.16), delirium (HR=1.80; 95% CI=1.24-2.62), and a high level of comorbidity (HR=1.62; 95% CI=1.09-2.40). Institutionalization (HR=1.92; 95% CI=1.37-2.71) and unplanned readmission (HR=4.47; 95% CI=3.16-2.71) within the follow-up period were also found as independent predictors.
The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects' prognosis favorably.
Revue d Épidémiologie et de Santé Publique 05/2012; 60(3):189-96. · 0.78 Impact Factor
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M. Drame,
J. -L. Novella,
D. Jolly,
I. Laniece,
D. Somme,
D. Heitz, J. -B. Gauvain,
T. Voisin,
B. De Wazieres,
R. Gonthier,
C. Jeandel,
P. Couturier,
O. Saint-Jean,
J. Ankri,
F. Blanchard,
Pierre Olivier Lang
[show abstract]
[hide abstract]
ABSTRACT: ObjectivesTo evaluate the predictive ability of four clinical frailty indexes as regards one-year rapid cognitive decline (RCD — defined
as the loss of at least 3 points on the MMSE score), and one-year institutional admission (IA) and mortality respectively;
and to measure their agreement for identifying groups at risk of these severe outcomes.
DesignOne-year follow-up and multicentre study of old patients participating in the SAFEs cohort study. Setting: Nine university
hospitals in France.
Participants1,306 patients aged 75 or older (mean age 85±6 years; 65% female) hospitalized in medical divisions through an Emergency department.
MeasurementsFour frailty indexes (Winograd; Rockwood; Donini; and Schoevaerdts) reflecting the multidimensionality of the frailty concept,
using an ordinal scoring system able to discriminate different grades of frailty, and constructed based on the accumulation
of identified deficits after comprehensive geriatric assessment conducted during the first week of hospital stay, were used
to categorize participants into three different grades of frailty: Gl — not frail; G2 — moderately frail; and G3 — severely
frail. Comparisons between groups were performed using Fisher’s exact test. Agreement between indexes was evaluated using
Cohen’s Kappa coefficient.
ResultsAll patients were classified as frail by at least one of the four indexes. The Winograd and Rockwood indexes mainly classified
subjects as G2 (85% and 96%), and the Donini and Schoevaerdts indexes mainly as G3 (71% and 67%). Among the SAFEs cohort population,
250, 1047 and 1,306 subjects were eligible for analyses of predictability for RCD, 1-year IA and 1-year mortality respectively.
At 1 year, 84 subjects (34%) experienced RCD, 377 (36%) were admitted into an institutional setting, and 445 (34%) had died
With the Rockwood index, all subjects who expenenced RCD were classified in G2; and in G2 and G3 when the Donini and Schoevaerdts
indexes were used No significant difference was found between frailty grade and RCD, whereas frailty grade was significantly
associated with an increased risk of IA and death, whatever the frailty index considered. Agreement between the different
indexes of frailty was poor with Kappa coefficients ranging from −0.02 to 0.15.
ConclusionThese findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that
further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding
of its pathophysiology.
Key wordsFrailty syndrome–frailty index–screening–comprehensive geriatric assessment–SAFES cohort
The Journal of Nutrition Health and Aging 04/2012; 15(8):699-705. · 2.69 Impact Factor
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Moustapha Dramé,
F. Fierobe,
P. -O. Lang,
D. Jolly,
F. Boyer,
R. Mahmoudi,
D. Somme,
I. Laniece,
D. Heitz, J. -B. Gauvain,
T. Voisin,
B. De Wazieres,
R. Gonthier,
J. Ankri,
O. Saint-Jean,
P. Couturier,
C. Jeandel,
F. Blanchard,
J. -L. Novella
[show abstract]
[hide abstract]
ABSTRACT: ObjectivesThe aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75
or over, hospitalised via the emergency department (ED).
DesignProspective multicentre cohort.
SettingNine French university teaching hospitals.
ParticipantsOne thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub group analysis
was performed on the 894 subjects with a caregiver.
MeasurementsPatients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify
predictors of institutionalisation at one year.
ResultsWithin one year after hospital admission, 210 (20.1%) subjects were institutionalised For the overall study population, age
>85 years (HR 1.6; 95% CI 1.1–2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1–2.4; p=0.007), balance disorders
(HR 1.6; 95%CI 1.1–2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4–2.6; p<0.001) proved to be independent
predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8;
95%CI 0.7–0.9; p<:0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver
burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall
study population.
ConclusionsCGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of
the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.
Key wordsElderly–institutionalisation–prediction–comprehensive geriatric assessment–SAFES Cohort
The Journal of Nutrition Health and Aging 04/2012; 15(5):399-403. · 2.69 Impact Factor
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M Dramé,
J-L Novella,
D Jolly,
I Lanièce,
D Somme,
D Heitz, J-B Gauvain,
T Voisin,
B De Wazières,
R Gonthier,
C Jeandel,
P Couturier,
O Saint-Jean,
J Ankri,
F Blanchard,
P-O Lang
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the predictive ability of four clinical frailty indexes as regards one-year rapid cognitive decline (RCD - defined as the loss of at least 3 points on the MMSE score), and one-year institutional admission (IA) and mortality respectively; and to measure their agreement for identifying groups at risk of these severe outcomes.
One-year follow-up and multicentre study of old patients participating in the SAFEs cohort study. Setting: Nine university hospitals in France.
1,306 patients aged 75 or older (mean age 85±6 years; 65% female) hospitalized in medical divisions through an Emergency department.
Four frailty indexes (Winograd; Rockwood; Donini; and Schoevaerdts) reflecting the multidimensionality of the frailty concept, using an ordinal scoring system able to discriminate different grades of frailty, and constructed based on the accumulation of identified deficits after comprehensive geriatric assessment conducted during the first week of hospital stay, were used to categorize participants into three different grades of frailty: G1 - not frail; G2 - moderately frail; and G3 - severely frail. Comparisons between groups were performed using Fisher's exact test. Agreement between indexes was evaluated using Cohen's Kappa coefficient.
All patients were classified as frail by at least one of the four indexes. The Winograd and Rockwood indexes mainly classified subjects as G2 (85% and 96%), and the Donini and Schoevaerdts indexes mainly as G3 (71% and 67%). Among the SAFEs cohort population, 250, 1047 and 1,306 subjects were eligible for analyses of predictability for RCD, 1-year IA and 1-year mortality respectively. At 1 year, 84 subjects (34%) experienced RCD, 377 (36%) were admitted into an institutional setting, and 445 (34%) had died. With the Rockwood index, all subjects who experienced RCD were classified in G2; and in G2 and G3 when the Donini and Schoevaerdts indexes were used. No significant difference was found between frailty grade and RCD, whereas frailty grade was significantly associated with an increased risk of IA and death, whatever the frailty index considered. Agreement between the different indexes of frailty was poor with Kappa coefficients ranging from -0.02 to 0.15.
These findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding of its pathophysiology.
The Journal of Nutrition Health and Aging 08/2011; 15(8):699-705. · 2.69 Impact Factor
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M Dramé,
F Fierobe,
P-O Lang,
D Jolly,
F Boyer,
R Mahmoudi,
D Somme,
I Laniece,
D Heitz, J-B Gauvain,
T Voisin,
B De Wazieres,
R Gonthier,
J Ankri,
O Saint-Jean,
P Couturier,
C Jeandel,
F Blanchard,
J-L Novella
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (ED).
Prospective multicentre cohort.
Nine French university teaching hospitals.
One thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub-group analysis was performed on the 894 subjects with a caregiver.
Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify predictors of institutionalisation at one year.
Within one year after hospital admission, 210 (20.1%) subjects were institutionalised. For the overall study population, age >85 years (HR 1.6; 95%CI 1.1-2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1-2.4; p=0.007), balance disorders (HR 1.6; 95%CI 1.1-2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4-2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8; 95%CI 0.7-0.9; p<0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population.
CGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.
The Journal of Nutrition Health and Aging 05/2011; 15(5):399-403. · 2.69 Impact Factor
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D Somme,
C Lazarovici,
M Dramé,
P Blanc,
P O Lang, J B Gauvain,
T Voisin,
R Gonthier,
B De Wazières,
C Jeandel,
P Couturier,
F Blanchard,
O Saint-Jean
[show abstract]
[hide abstract]
ABSTRACT: We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR)=1.79 (1.38-2.32) (95% confidence interval=95% CI); "failure to thrive" syndrome OR=1.54 (1.01-2.35), depression: OR=1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR=1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the "geriatrics patient" is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system.
Archives of gerontology and geriatrics 03/2010; 52(1):40-5. · 1.36 Impact Factor
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M Drame,
N Jovenin,
J L Novella,
P O Lang,
D Somme,
I Laniece,
T Voisin,
P Blanc,
P Couturier, J B Gauvain,
F Blanchard,
D Jolly
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management. Design: Prospective multicentre cohort.
Nine French teaching hospitals.
One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED).
Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality.
Crude mortality rate after a six week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1-3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5-16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2-33.1; p < .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 - 0.75; p < .001). The six-week mortality rate increased significantly (p < .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5-1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4-12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1-24.7) in the highest risk group.
A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.
The Journal of Nutrition Health and Aging 10/2008; 12(8):599-604. · 2.69 Impact Factor
