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Cover of Common Syndromes in Older Adults Related to Primary and Secondary Prevention

Common Syndromes in Older Adults Related to Primary and Secondary Prevention

Evidence Syntheses/Technology Assessments, No. 87

Investigators: , MD, , PhD, GNP-BC, RN, , MD, MS, and , MD, MS.

Minnesota Evidence-Based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-05157-EF-1

Structured Abstract

Objectives:

To create a systematic synthesis of the published evidence about the prevalence of eight geriatric syndromes and their association with survival and institutionalization, and to provide a review of models that report survival in elderly populations.

Data Sources:

Original epidemiologic studies were sought from several databases to identify articles published in English from January 1, 1990 to April 25, 2010.

Review Methods:

We identified studies of multiple morbidities, mild cognitive impairment, frailty, disability, sarcopenia, malnutrition, homeostenosis (i.e., impaired homeostasis), and chronic inflammation in the general elderly population and age, race, and sex subgroups. We developed standardized forms using different definitions of these syndromes and abstracted prevalence of the syndromes. Multivariate adjusted risks of mortality and institutionalization for elderly patients with syndromes were abstracted to calculate remaining life expectancy. Pooled analyses were conducted with random effects models. Statistical and decisionmaking models were appraised for content, simplicity, and validation.

Results:

Of the 2,377 publications retrieved, 509 publications of 123 studies were eligible for review. Definitions varied within each syndrome and overlapped across all syndromes. Prevalence estimates increased with age. African Americans had higher prevalence of multiple morbidities, frailty, malnutrition, and disability when compared to Caucasians. Evidence on other minority subgroups was sparse. All syndromes were associated with increased risk of death and institutionalization. A negative association between prevalence of a syndrome and its effect on survival was evident across all syndromes. Impaired homeostasis and dementia were associated with the lowest survival among elderly persons when compared to the general population. In the young-old, ages 65–74 years, those with homeostenosis, poor health, or advanced dementia suffered significant decreases in predicted life expectancy. The syndromes affected the likelihood of death more among the young-old. In those older than age 90 years, the added value of factoring in conditions and syndromes to evaluate the link to mortality beyond 1 year was minimal. Complexity was not associated with better mortality models in elderly persons.

Conclusions:

Syndromes are not independent; definitions and prevalence estimates overlap substantially. Some minority subpopulations had higher prevalence of the syndromes. Less inclusive definitions had lower prevalence but were better predictors of outcomes. Complex mortality models added less benefit to simpler models that included age, specific diseases, and impact on overall health and functioning. For younger old persons, syndromes most strongly linked to mortality were homeostenosis, poor health, and dementia.

Contents

Acknowledgments: The authors thank Dorothee Aeppli, PhD, for her calculations of life expectancy among populations with increased risk of death; Christopher A. Warlick, MD, PhD, for his recommendation about models that report mortality in elderly patients; librarian Judith Stanke, MA, for her contributions to the literature search; Rema Ramakrishnan, MD, MPH candidate, Shiyi Wang, MD, PhD candidate, Jing Du, PhD candidate, Warren Manyara, MD, MHA candidate, and Molly Moor, PhD candidate, for their assistance with the literature search and data abstraction; Jeannine Ouellette for her help in writing the report; Marilyn Eells for editing and formatting the report; and Karen Rashke, Yaminah Oliver, and Christa Prodzinski for assistance with data entry and formatting tables.

The authors also thank Kathleen Buckwalter, PhD, RN, Thomas Gill, MD, Jack Guralnik, MD, PhD, Rosanne Leipzig, MD, PhD, Joseph Ouslander, MD, Barbara Resnick, PhD, Albert L. Siu, MD, MSPH, and Gregg Warshaw, MD, for serving on the Technical Expert Panel; and Linda Fried, MD, MPH, and Linda Kinsinger, MD, for reviewing the draft of this report and providing helpful recommendations for revisions and clarifications.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA 290-2007-10064-1, Prepared by: Minnesota Evidence-Based Practice Center, Minneapolis, Minnesota

Suggested citation:

Kane RL, Talley KM, Shamliyan T, Pacala JT. Common Syndromes in Older Adults Related to Primary and Secondary Prevention. Evidence Report/Technology Assessment No. 87. AHRQ Publication No. 11-05157-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; July 2011.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2007-10064-1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Bookshelf ID: NBK62074PMID: 21901865

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