Inessa Cohen, Pedro K. Curiati, Christian V. Morinaga, Ling Han, Tanish Gandhi, Katy Araujo, Thiago J. Avelino-Silva, Luann M. Bianco, Cynthia A. Brandt, Sandra Capelli, Christopher R. Carpenter, Daniel S. Cruz, Scott M. Dresden, Ivy L. Fishman, Katrina Gipson, Elizabeth Gray, S. Nicole Hastings, William W. Hung, Raymond Kang, Mechelle Lockhart, Daniella Meeker, Ugochi Ohuabunwa, Sierra Ottilie-Kovelman, Timothy F. Platts-Mills, Jacqueline Sandoval, Natalia Sifnugel, Zachary Taylor, Debra F. Tomasino, Camille P. Vaughan, Márlon J. R. Aliberti, Ula Hwang
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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).</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>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. 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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).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 5","pages":"1419-1428"},"PeriodicalIF":4.3000,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department\",\"authors\":\"Inessa Cohen, Pedro K. 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引用次数: 0
摘要
背景：评估急诊科（ED）老年人脆弱性的现有风险评分显示出有限的预测能力，特别是在不同的人群中。我们研究了一个快速且易于管理的老年脆弱性评分系统与美国（US）和巴西（BR）通过急诊室入住多家医院的老年患者的功能下降和死亡率之间的关系。方法：联合、国际、多中心观察研究≥65岁美国和BR住院ED患者。PRO-AGE评分的6个标准(身体损伤、近期住院、年龄较大[≥90]、急性精神改变、变瘦和疲惫；主;分数越高=脆弱性越大)在入院时进行评估。我们使用比例风险模型来研究PRO-AGE评分组与90天死亡率和功能下降之间的关系，功能下降定义为日常生活活动（ADL）和工具性ADL （IADL）的新依赖性，在调整了年龄、性别、种族和民族、教育程度、Charlson共病评分和研究地点之后。死亡被认为是功能衰退结果的竞争事件。结果：共纳入1390例患者(US = 560；巴西= 830)。在两个队列中，高年龄组的90天死亡风险高于低年龄组（参考）(US: HR = 11.76；95%置信区间[CI] = 2.56-54.04；Br: hr = 12.29；95% CI = 3.54-42.59)，而新发生90天ADL残疾的风险较高(HR = 2.08；95% CI = 1.21-3.56)和中间组(HR = 2.10；95% CI = 1.35-3.27)，但BR只有上层组(HR = 1.70；95% ci = 1.02-2.85)。结论：在美国和BR住院的老年ED患者中，较高的PRO-AGE评分与死亡率和功能下降相关，证明了其作为老年脆弱性风险评分的普遍性。
The PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department
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.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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