Pathways after inpatient admission in very advanced age: A Portuguese nationwide study

Further survival at age 100: Findings from the Oporto Centenarian study

BACKGROUND

This paper aims to identify the health-related predictors of survival in centenarians.

METHODS

A population-based study conducted in North Portugal (PT100) followed 140 individuals from the age of 100+ years. A detailed questionnaire at baseline was completed including information on sociodemographic characteristics, physical health, functional, cognitive, and nutritional status and life-style. Survival of study participants was checked every six months over the period of December 2013 until June 2019.

RESULTS

In the univariate Cox proportional hazards model, longer survival was associated with the absence of acute disease, better functional status, absence of physical fatigue and better cognition. Multivariate analysis revealed that acute disease, functional status and physical fatigue remained significant.

CONCLUSIONS

Acute disease, functional status and physical fatigue are predictors of survival in the PT100 centenarians.

Perceived risk of institutionalization, hospitalization, and death in oldest old primary care patients

OBJECTIVES

This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns.

METHOD

GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes.

RESULTS

The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of institutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68).

CONCLUSIONS

The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for institutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument's use.