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Development of a Predictive Score for Mortality at 3- and 12-Month after Discharge from an Acute Geriatric Unit as a Trigger for Advanced Care Planning

Abstract : BACKGROUND: There is a need for a mortality score that can be used to trigger advanced care planning among older patients discharged from acute geriatric units (AGUs). OBJECTIVE: To develop a prognostic score for 3- and 12-month mortality after discharge from an AGU, based on a comprehensive geriatric assessment, in-hospital events, and the exclusion of patients already receiving palliative care. METHODS: DAMAGE is a French multicentre, prospective, cohort study. The broad inclusion criteria ensured that the cohort is representative of patients treated in an AGU. The DAMAGE participants underwent a comprehensive geriatric assessment, a daily clinical check-up, and follow-up visits 3 and 12 months after discharge. Multivariable logistic regression models were used to develop a prognostic score for the derivation and validation subsets. RESULTS: 3509 patients were assessed and 3112 were included. The patient population was very older and frail or dependant, with a high proportion of deaths at 3 months (n=455, 14.8%) and at 12 months (n=1014, 33%). The score predicted an individual risk of mortality ranging from 1% to 80% at 3 months and between 5% and 93% at 12 months, with an area under the receiving operator characteristic curve in the validation cohort of 0.728 at 3 months and 0.733 at 12 months. CONCLUSIONS: Our score predicted a broad range of risks of death after discharge from the AGU. Having this information at the time of hospital discharge might trigger a discussion on advanced care planning and end-of-life care with very old, frail patients.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03720180
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Soumis le : lundi 11 juillet 2022 - 17:21:47
Dernière modification le : jeudi 18 août 2022 - 15:36:21

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Guillaume Deschasse, Frédéric Bloch, Elodie Drumez, Anne Charpentier, Fabien Visade, et al.. Development of a Predictive Score for Mortality at 3- and 12-Month after Discharge from an Acute Geriatric Unit as a Trigger for Advanced Care Planning. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 2021, pp.glab217. ⟨10.1093/gerona/glab217⟩. ⟨hal-03720180⟩

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