The Association Between Geriatric Syndromes and Survival

OBJECTIVES: To ascertain the effect on survival of eight common geriatric syndromes (multiple comorbidities, cognitive impairment, frailty, disability, sarcopenia, malnutrition, homeostenosis, and chronic inflammation), identified by an expert panel of academic geriatricians. DESIGN: A systematic literature review sought studies from a variety of sources to compare survival and life expectancy of individuals with geriatric syndromes with those of the general population. SETTING: Studies used reflected the general population. PARTICIPANTS: Community-dwelling persons aged 65 and older. MEASUREMENTS: Eight geriatric syndromes (multiple definitions) and survival. RESULTS: Two thousand three hundred seventy-four publications were retrieved, and 509 publications of 123 studies were included. Seven geriatric syndromes (multiple comorbidities, cognitive impairment, frailty, disability, malnutrition, impaired homeostasis, and chronic inflammation) were associated with poor survival. In each case, the prevalence of a syndrome was negatively associated with mortality. Malnutrition and impaired homeostasis exerted twice the influence of factors such as multiple comorbidities and frailty. From age 65 to 74, only those who are very ill or frail (e.g., impaired homeostasis, low body mass index, or advanced dementia) have a higher risk of mortality than average older adults. In the old-old, particularly aged 90 and older, the added value of predicting survival beyond 1 year is minimal. CONCLUSION: Geriatric syndrome information is helpful to understanding survival for younger old persons but provides little information about survival for the very old. Complex survival models add comparatively little benefit to more simply measured and calculated models.