title: Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals.
abstract: BACKGROUND
  Older patients often suffer from multiple comorbid conditions. Few comorbidity indices are valid and reliable in the elderly and were rarely compared.
  
  
  OBJECTIVE
  To compare the performance, relevance, and ability of 6 widely used and validated comorbidity indices--Charlson Comorbidity Index, Cumulative Illness Rating Scale-Geriatrics, Index of Coexistent Diseases, Kaplan, Geriatric Index of Comorbidity (GIC), and Chronic Disease Score--to predict adverse outcomes after discharge (1-year risk of rehospitalization, institutionalization, and death).
  
  
  METHODS
  Prospective study with 1-year follow-up, between January 2004 and December 2005 in 444 elderly patients (mean age, 85; 74% female) discharged from acute geriatric hospital, Geneva University Hospitals.
  
  
  RESULTS
  In univariate analyses, Cumulative Illness Rating Scale?Geriatrics and GIC were the predictors with the largest coefficient of determination for mortality with (R(2) of 9.3%, respectively 8.8%). GIC was also the only significant predictor of institutionalization (R(2) = 6.0%). Higher risk of readmission was significantly associated with GIC (R(2) = 14.0%), Cumulative Illness Rating Scale-Geriatrics (R(2) = 5.6%), Charlson Comorbidity Index (R(2) = 3.1%), and Chronic Disease Score (R(2) = 1.7).
  
  
  CONCLUSIONS
  Understanding how to efficiently predict these adverse outcomes in hospitalized elders is important for a variety of clinical and policy reasons. GIC and Cumulative Illness Rating Scale-Geriatrics may improve hospital discharge planning in a geriatric hospital treating very old patients with acute disease.
authors: Rehabilitation and Geriatrics Department, Geneva University Hospitals and University of Geneva, Thônex, Switzerland. dina.zekry@hcuge.ch
authors: Dina
authors: D
authors: Zekry
authors: Bernardo Hermont
authors: BH
authors: Loures Valle
authors: Cristophe
authors: C
authors: Graf
authors: Jean-Pierre
authors: JP
authors: Michel
authors: Gabriel
authors: G
authors: Gold
authors: Karl-Heinz
authors: KH
authors: Krause
authors: François R
authors: FR
authors: Herrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology