Key result
In older patients hospitalized for chronic disease exacerbation, four clinically significant multimorbidity clusters (osteoarticular, psychogeriatric, cardiorespiratory, minor chronic disease) were identified.
Why the study?
To estimate the frequency of chronic conditions and geriatric syndromes and identify multimorbidity clusters in older patients hospitalised for an exacerbation of chronic conditions.
Cohort (n=740)
Yes
Soft clustering techniques can identify clinically relevant multimorbidity patterns in older hospitalized patients to guide healthcare reorganization.
Answers are grounded in this paper and cite their sources.
May guide comprehensive geriatric assessment in multimorbid elderly admissions; leaves open whether cluster-informed strategies improve outcomes.
OBJECTIVES: To estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients. DESIGN: Multicentre, prospective cohort study. SETTING: Internal medicine or geriatric services of five general teaching hospitals in Spain. PARTICIPANTS: 740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Active chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team. RESULTS: 740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters. CONCLUSIONS: In older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients. TRIAL REGISTRATION NUMBER: NCT02830425.
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Baré et al. (2021) conducted a cohort in Exacerbation of chronic conditions (n=740). Multimorbidity patterns was evaluated on Active chronic conditions and geriatric syndromes, clinical management score, and destination at discharge. In older patients hospitalized for chronic disease exacerbation, four clinically significant multimorbidity clusters (osteoarticular, psychogeriatric, cardiorespiratory, minor chronic disease) were identified.
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