Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up
Objective The prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimens...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-12-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e086975.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841536616738324480 |
|---|---|
| author | Thomas Benzing Jill Stegemann Anna Maria Affeldt Luisa Mück Anne Ferring Laura Gerhards Lena Pickert Annika Bausch Philipp Antczak M Cristina Polidori |
| author_facet | Thomas Benzing Jill Stegemann Anna Maria Affeldt Luisa Mück Anne Ferring Laura Gerhards Lena Pickert Annika Bausch Philipp Antczak M Cristina Polidori |
| author_sort | Thomas Benzing |
| collection | DOAJ |
| description | Objective The prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimensional prognostic signature in older patients admitted to different healthcare settings.Design Pooled secondary analysis of three longitudinal interventional studies with the 3- and 6-month follow-up data collection on mortality and rehospitalisation.Setting Inpatients in an internal medicine ward (n=495), inpatients in an ageing medicine ward (n=123) and outpatients from a general practice (n=105).Participants A total of 734 patients with multimorbidity who aged over 60 years were recruited between August 2016 and July 2020 (mean age 77.8 years, SD 6.2 and 43% female).Outcome measures Comprehensive Geriatric Assessment (CGA), including Cumulative Illness Rating Scale (CIRS), 17 GS and 10 GR, and the CGA-based Multidimensional Prognostic Index (MPI) as a measure of multidimensional prognosis and frailty were assessed. Based on a general linear model and a hierarchical clustering method, clusters of comorbidities, GS and GR were obtained.Results The study identified five clusters of GR-related GS, namely, psychosocial, iatrogenic, neurovegetative, sensorimotor and fluid dysbalance, along with two clusters related to GR, focusing on independence achievement and requirements- circumstances. Additionally, two clusters were identified pertaining to the CIRS, encompassing sensory-vegetative and heart-kidney morbidity. Patients within the iatrogenic cluster exhibited significantly higher MPI and readmissions during follow-up compared with those outside this cluster (p<0.001). Furthermore, membership in the fluid dysbalance or psychosocial cluster was associated with a significantly increased mortality rate during follow-up (p<0.001).Conclusions A feasible combination of GR and GS in clinical routine enables the identification of clusters with clear prognostic relevance, which may improve prognosis through tailored treatment.Trial registration numbers DRKS00010606/DRKS00013791/DRKS00017094 MPI_InGAH, DRKS00012820 MPI_NoGeP and DRKS00015996 VNKN. |
| format | Article |
| id | doaj-art-8f26f91a00f542f1a4d646a58e0717b5 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8f26f91a00f542f1a4d646a58e0717b52025-01-14T13:30:12ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-086975Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-upThomas Benzing0Jill Stegemann1Anna Maria Affeldt2Luisa Mück3Anne Ferring4Laura Gerhards5Lena Pickert6Annika Bausch7Philipp Antczak8M Cristina Polidori91 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany1 Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, GermanyObjective The prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimensional prognostic signature in older patients admitted to different healthcare settings.Design Pooled secondary analysis of three longitudinal interventional studies with the 3- and 6-month follow-up data collection on mortality and rehospitalisation.Setting Inpatients in an internal medicine ward (n=495), inpatients in an ageing medicine ward (n=123) and outpatients from a general practice (n=105).Participants A total of 734 patients with multimorbidity who aged over 60 years were recruited between August 2016 and July 2020 (mean age 77.8 years, SD 6.2 and 43% female).Outcome measures Comprehensive Geriatric Assessment (CGA), including Cumulative Illness Rating Scale (CIRS), 17 GS and 10 GR, and the CGA-based Multidimensional Prognostic Index (MPI) as a measure of multidimensional prognosis and frailty were assessed. Based on a general linear model and a hierarchical clustering method, clusters of comorbidities, GS and GR were obtained.Results The study identified five clusters of GR-related GS, namely, psychosocial, iatrogenic, neurovegetative, sensorimotor and fluid dysbalance, along with two clusters related to GR, focusing on independence achievement and requirements- circumstances. Additionally, two clusters were identified pertaining to the CIRS, encompassing sensory-vegetative and heart-kidney morbidity. Patients within the iatrogenic cluster exhibited significantly higher MPI and readmissions during follow-up compared with those outside this cluster (p<0.001). Furthermore, membership in the fluid dysbalance or psychosocial cluster was associated with a significantly increased mortality rate during follow-up (p<0.001).Conclusions A feasible combination of GR and GS in clinical routine enables the identification of clusters with clear prognostic relevance, which may improve prognosis through tailored treatment.Trial registration numbers DRKS00010606/DRKS00013791/DRKS00017094 MPI_InGAH, DRKS00012820 MPI_NoGeP and DRKS00015996 VNKN.https://bmjopen.bmj.com/content/14/12/e086975.full |
| spellingShingle | Thomas Benzing Jill Stegemann Anna Maria Affeldt Luisa Mück Anne Ferring Laura Gerhards Lena Pickert Annika Bausch Philipp Antczak M Cristina Polidori Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up BMJ Open |
| title | Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up |
| title_full | Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up |
| title_fullStr | Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up |
| title_full_unstemmed | Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up |
| title_short | Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up |
| title_sort | prognostic signature of multimorbidity geriatric syndromes and resources cluster in older in and outpatients a pooled secondary analysis with a 6 month follow up |
| url | https://bmjopen.bmj.com/content/14/12/e086975.full |
| work_keys_str_mv | AT thomasbenzing prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT jillstegemann prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT annamariaaffeldt prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT luisamuck prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT anneferring prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT lauragerhards prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT lenapickert prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT annikabausch prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT philippantczak prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup AT mcristinapolidori prognosticsignatureofmultimorbiditygeriatricsyndromesandresourcesclusterinolderinandoutpatientsapooledsecondaryanalysiswitha6monthfollowup |