Development of a Predictive Score for Mortality at 3 and 12 Months After Discharge From an Acute Geriatric Unit as a Trigger for Advanced Care Planning

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Biological sciences and medical sciences, 2022-08, Vol.77 (8), p.1665-1672
• Main Authors: Deschasse, Guillaume, Bloch, Frédéric, Drumez, Elodie, Charpentier, Anne, Visade, Fabien, Delecluse, Celine, Loggia, Gilles, Lescure, Pascale, Attier-Żmudka, Jadwiga, Bloch, Jennifer, Gaxatte, Cedric, Van Den Berghe, William's, Puisieux, François, Beuscart, Jean-Baptiste
• Format: Article
• Language: English
• Subjects: Advance directives; Clinical trials; Geriatrics; Medical research; Mortality; Palliative care; Patients; Regression analysis
• ISSN: 1079-5006; 1758-535X
• DOI: 10.1093/gerona/glab217

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 We developed 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 Devenir Après la Médecine Aigue Gériatrique (DAMAGE) is a French multicenter, 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 checkup, 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 A total of 3 509 patients were assessed and 3 112 were included. The patient population was very old and frail or dependant, with a high proportion of deaths at 3 months (n = 455, 14.8%) and at 12 months (n = 1 014, 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. Clinical Trials Registration Number: NCT02949635.