PREDICTORS OF MORTALITY IN OUTPATIENT GERIATRIC EVALUATION AND MANAGEMENT CLINIC PATIENTS

Background. This study describes characteristics and predictors of sur vival in an outpatient Geriatric Evaluation and Management (GEM) popul ation. Methods. Prospective evaluation and longitudinal follow-up of c onsecutive patients (N = 636) seen in a GEM Clinic between January 198 6 and September 1991. Results, The typical patient was 78.4 years of a ge, White, female (73%), unmarried (66%), and living with a spouse or relative (47%). Although two-thirds were demented, most were independe nt in Activities of Daily Living (ADL) and partially dependent in Inst rumental Activities of Daily Living (IADL). Subjects were followed for an average of 25 months. In bivariate analysis, IADL was the stronges t predictor of survival(O.R. = 4.4). Higher ADL, better cognitive stat us, lower comorbid illness, and lack of recent hospitalization were al so predictive of survival. In stepwise logistic regression, only IADL( O.R. = 4.2) and comorbid illness (O.R. = 1.5) predicted survival. In K aplan-Meier Lifetable Analysis, survival at two years was 91% in the l east dependent IADL group while survival was 75% in the most dependent group. Comorbid illness was the only factor that improved prediction of survival above that seen with IADL alone. When subjects are stratif ied by both function and illness, mortality was 36% in the ill and dis abled group and 8% in those of high function and limited illness. Conc lusions. IADL and comorbid illness scores offer a means of stratifying subjects for risk of death and may be useful in evaluating and compar ing mortality experience in outpatient GEM and control populations. St ratification may increase the likelihood that studies aimed at improvi ng survival will detect a difference resulting from the intervention.