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Can information on functional and cognitive status improve short-term mortality risk prediction among community-dwelling older persons? A cohort study using a UK primary care database

Research output: Contribution to journalArticle

Janet Sultana, Andrea Fontana, Francesco Giorgianni, Giorgio Basile, Elisabetta Patorno, Alberto Pilotto, Mariam Molokhia, Robert James Stewart, Miriam C. J. M. Sturkenboom, Gianluca Trifirò

Original languageEnglish
Pages (from-to)31—39
Number of pages9
JournalClinical Epidemiology
DOIs
Accepted/In press11 Oct 2017
Published19 Dec 2017

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Abstract

Background: Functional and cognitive domains have rarely been evaluated for their prognostic value in general practice (GP) databases. The aim of this study was to identify functional and cognitive domains in The Health Improvement Network (THIN) and to evaluate their additional value for the prediction of one-month and one-year mortality in elderly persons.
Methods: A cohort study was conducted in a UK nationwide GP database. A total of 1,193,268 patients ≥65 years, of whom 15,300 persons had dementia, were identified from 2000-2012. Information on mobility, dressing and accommodation was recorded in THIN frequently enough to be analyzed further. Cognition data could not be used due to very poor recording of data in THIN. One-year and one-month mortality was predicted using logistic models containing the variables age, sex, a disease score and functionality status.
Results: A significant but moderate improvement on one-year and one-month mortality prediction in elderly people was observed by adding accommodation to the variables age, sex and disease score, as the c-statistic (95%CI) increased from 0.71 (0.70-0.72) to 0.76 (0.75-0.77) and 0.73 (0.71-0.75) to 0.79 (0.77-0.80), respectively. A less notable improvement in the prediction of one-year and one-month mortality was observed in persons with dementia.
Conclusions: Functional domains moderately improved the accuracy of a model including age, sex and co-morbidities in predicting one-year and one-year mortality risk among community-dwelling older people, but were much less able to predict mortality in persons with dementia. Cognition could not be explored as a predictor of mortality due to insufficient data being recorded.

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