Predicting 2-Year Risk of Developing Pneumonia in Older Adults without Dementia
- Autores: Michael L. Jackson, Rod Walker, Sei Lee-, Eric Larson, Sascha Dublin
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 64, Nº. 7, 2016, págs. 1439-1447
- Idioma: inglés
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Resumen
Objectives To develop three prognostic indices of varying degree of required detail for 2-year pneumonia risk in older adults.
Design Retrospective cohort study.
Setting Group Health (GH), an integrated healthcare delivery system.
Participants Community-dwelling dementia-free individuals aged 65 and older who had been GH members for at least 2 years before start of follow-up and were enrolled in the Adult Changes in Thought study (N = 3,375; development cohort, n = 2,250; validation cohort, n = 1,125.
Measurements Potential pneumonia risk factors were identified from questionnaire data and interviewer assessments of functional status, medical history, smoking and alcohol use, cognitive function, personal care, and problem solving. Risk factors were also identified based on physical measures such as grip strength and gait speed and administrative database information on comorbid illnesses, laboratory tests, and prescriptions dispensed. Incident community-acquired pneumonia was defined presumptively from administrative data and validated using medical record review.
Results Participants (59% female) contributed 12,998 visits at which risk factors were assessed; 642 pneumonia events were observed during follow-up. Age, sex, chronic obstructive pulmonary disease, congestive heart failure, body mass index, and use of inhaled or oral corticosteroids were critical predictors in all prognostic indices. A risk score based on these seven variables, information on which is commonly available in electronic medical records (EMRs), had equal or better performance (c-index = 0.69 in the validation cohort) than scores including more-detailed data such as functional status.
Conclusion Data commonly available in EMRs can stratify older adults into groups with varying subsequent 2-year pneumonia risk.
