期刊文献

The PRO‐AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department 收藏

Pro -age工具及其与急诊室接纳的老年人的后期结局的关联

原文求助发布源

作者

Inessa Cohen (https://orcid.org/0000-0002-5807-2635) [1];Pedro K. Curiati [2];Christian V. Morinaga [3];Ling Han [4];Tanish Gandhi [5];Katy Araujo [6];Thiago J. Avelino‐Silva [7];Luann M. Bianco [8];Cynthia A. Brandt [9];Sandra Capelli [10];Christopher R. Carpenter (https://orcid.org/0000-0002-2603-7157) [11];Daniel S. Cruz (https://orcid.org/0000-0001-9722-2723) [12];Scott M. Dresden [13];Ivy L. Fishman [14];Katrina Gipson [15];Elizabeth Gray [16];S. Nicole Hastings [17];William W. Hung [18];Raymond Kang [19];Mechelle Lockhart [20];Daniella Meeker [21];Ugochi Ohuabunwa (https://orcid.org/0000-0001-7214-9507) [22];Sierra Ottilie‐Kovelman [23];Timothy F. Platts‐Mills [24];Jacqueline Sandoval (https://orcid.org/0000-0002-5469-6272) [25];Natalia Sifnugel [26];Zachary Taylor [27];Debra F. Tomasino [28];Camille P. Vaughan (https://orcid.org/0000-0001-6713-794X) [29];Márlon J. R. Aliberti (https://orcid.org/0000-0001-7467-1745) [30];Ula Hwang (https://orcid.org/0000-0002-3715-3073) [31];

作者单位

[1]Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA; [2]Geriatric Emergency Department Research Group (ProAGE) Hospital Sírio‐Libanês São Paulo Brazil; [3]Geriatric Emergency Department Research Group (ProAGE) Hospital Sírio‐Libanês São Paulo Brazil; [4]Department of Internal Medicine, Section of Geriatrics Yale School of Medicine New Haven Connecticut USA; [5]The Ohio State University College of Medicine Columbus Ohio USA; [6]Department of Internal Medicine, Section of Geriatrics Yale School of Medicine New Haven Connecticut USA; [7]Geriatric Emergency Department Research Group (ProAGE) Hospital Sírio‐Libanês São Paulo Brazil; [8]Department of Internal Medicine, Section of Geriatrics Yale School of Medicine New Haven Connecticut USA; [9]Department of Biomedical Informatics and Data Science Yale University School of Medicine New Haven Connecticut USA; [10]Department of Internal Medicine, Section of Geriatrics Yale School of Medicine New Haven Connecticut USA; [11]Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA; [12]Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA; [13]Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA; [14]Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA; [15]Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA; [16]Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA; [17]Center of Innovation to Accelerate Discovery and Practice Transformation Durham VA Health Care System Durham North Carolina USA; [18]Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA; [19]Center for Community Health Northwestern University Feinberg School of Medicine Chicago Illinois USA; [20]Division of Geriatrics & Gerontology, Department of Medicine Emory University School of Medicine Atlanta Georgia USA; [21]Department of Biomedical Informatics and Data Science Yale University School of Medicine New Haven Connecticut USA; [22]Division of Geriatrics & Gerontology, Department of Medicine Emory University School of Medicine Atlanta Georgia USA; [23]Department of Internal Medicine, Section of Geriatrics Yale School of Medicine New Haven Connecticut USA; [24]Ophirex Inc. Corte Madera California USA; [25]Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA; [26]Department of Emergency Medicine NYU Grossman School of Medicine New York New York USA; [27]Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA; [28]Department of Emergency Medicine NYU Grossman School of Medicine New York New York USA; [29]Division of Geriatrics & Gerontology, Department of Medicine Emory University School of Medicine Atlanta Georgia USA; [30]Geriatric Emergency Department Research Group (ProAGE) Hospital Sírio‐Libanês São Paulo Brazil; [31]Geriatric Research, Education and Clinical Center James J. Peters VA Medical Center Bronx New York USA;

发布日期

2025-1-22

页码

1419-1428

DOI

10.1111/jgs.19374

来源信息

Journal of the American Geriatrics Society ISSN：0002-8614, 2025年, 73卷, 5期, 1419-1428页

摘要

【ABSTRACT】【Background】Existing risk scores assessing geriatric vulnerability in the emergency department (ED) have shown limited predictive power, especially in diverse populations. We investigated the relationship of a quick and easy‐to‐administer geriatric vulnerability scoring system with functional decline and mortality in older patients admitted to multiple hospitals through the ED in the United States (US) and Brazil (BR).【Method】Federated, international, multicenter observational study of hospitalized ED patients aged ≥ 65 from US and BR. The six criteria from the PRO‐AGE score (Physical impairment, Recent hospitalization, Older age [≥ 90], Acute mental alteration, Getting thinner, and Exhaustion; 0–8; higher scores = greater vulnerability) were assessed on admission. We used proportional hazards models to investigate the relationships between PRO‐AGE score groups and 90‐day mortality and functional decline, defined as new dependence in activities of daily living (ADL) and instrumental ADL (IADL), after adjusting for age, sex, race and ethnicity, education, Charlson comorbidity score, and study site. Death was considered a competing event for the functional decline outcome.【Results】A total of 1390 patients were included (US = 560; Brazil = 830). The 90‐day risk of death was higher for the upper compared with the lower (reference) PRO‐AGE group in both cohorts (US: HR = 11.76; 95% confidence interval [CI] = 2.56–54.04; BR: HR = 12.29; 95% CI = 3.54–42.59), whereas the risk of new 90‐day ADL disability was higher for upper (HR = 2.08; 95% CI = 1.21–3.56) and middle groups (HR = 2.10; 95% CI = 1.35–3.27) in the US but only the upper group in BR (HR = 1.70; 95% CI = 1.02–2.85).【Conclusion】A higher PRO‐AGE score was associated with mortality and functional decline in older ED patients admitted to hospitals in the US and BR, demonstrating its generalizability as a geriatric vulnerability risk score.

摘要译文

【摘要】【背景】现有的风险评分评估急诊科（ED）的老年脆弱性的现有风险评分表明，预测能力有限，尤其是在不同人群中。我们调查了一个快速，容易到达的老年脆弱性评分系统与通过ED在美国ED接纳多家医院的老年患者的功能下降和死亡率的关系。在入院时，评估了亲龄分数的六个标准（身体障碍，最近的住院，≥90]，急性心理改变，急剧变化和精疲力尽； 0-8；更高的分数=更大的脆弱性）。我们使用比例危害模型来研究亲年评分组与90天死亡率和功能下降之间的关系，定义为在调整年龄，性别，种族和种族和种族，教育，Charlson合并症以及研究地点以及研究地点以及研究地点以及研究地点和研究地点后，定义为日常生活（ADL）和乐器ADL（IADL）的新依赖性。死亡被认为是功能下降结果的竞争事件。结果总共包括1390名患者（US = 560；巴西= 830）。与两个队列中的较低（参考）较高年龄组相比，上层的90天死亡风险更高（我们：HR = 11.76; 95％置信区间= 2.56-54.04; BR：HR：HR = 12.29; 95％CI; 95％CI = 3.54–42.59），而新的90 disaborabory则; 90 -90 -disabory; 90; 90; 90; 90; 90; 90; hr;CI = 1.21–3.56）和中部组（HR = 2.10; 95％CI = 1.35–3.27）在美国，但仅在BR中的上层组（HR = 1.70; 95％CI = 1.02–2.85）。脆弱性风险评分。