The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition
Abstract Background It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04409-9 |
| _version_ | 1797636687995600896 |
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| author | Ana Alejandra Esteban-Burgos César Hueso-Montoro Emilio Mota-Romero Rafael Montoya-Juarez Xavier Gomez-Batiste María Paz Garcia-Caro |
| author_facet | Ana Alejandra Esteban-Burgos César Hueso-Montoro Emilio Mota-Romero Rafael Montoya-Juarez Xavier Gomez-Batiste María Paz Garcia-Caro |
| author_sort | Ana Alejandra Esteban-Burgos |
| collection | DOAJ |
| description | Abstract Background It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. Methods This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. Results The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526–0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499–0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566–0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432–0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. Conclusions PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition. |
| first_indexed | 2024-03-11T12:37:42Z |
| format | Article |
| id | doaj.art-773a3649641946a5a6fa7fd86360a4ad |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-11T12:37:42Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-773a3649641946a5a6fa7fd86360a4ad2023-11-05T12:29:03ZengBMCBMC Geriatrics1471-23182023-11-012311910.1186/s12877-023-04409-9The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic conditionAna Alejandra Esteban-Burgos0César Hueso-Montoro1Emilio Mota-Romero2Rafael Montoya-Juarez3Xavier Gomez-Batiste4María Paz Garcia-Caro5Departamento de Enfermería, Universidad de JaénDepartamento de Enfermería, Universidad de JaénInstituto Investigación Biosanitaria Granada (IBS)Instituto Investigación Biosanitaria Granada (IBS)Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC)Instituto Investigación Biosanitaria Granada (IBS)Abstract Background It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. Methods This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. Results The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526–0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499–0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566–0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432–0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. Conclusions PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.https://doi.org/10.1186/s12877-023-04409-9Palliative carePrognosisNursing homesFrail elderlyAgedPalliative medicine |
| spellingShingle | Ana Alejandra Esteban-Burgos César Hueso-Montoro Emilio Mota-Romero Rafael Montoya-Juarez Xavier Gomez-Batiste María Paz Garcia-Caro The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition BMC Geriatrics Palliative care Prognosis Nursing homes Frail elderly Aged Palliative medicine |
| title | The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition |
| title_full | The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition |
| title_fullStr | The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition |
| title_full_unstemmed | The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition |
| title_short | The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition |
| title_sort | prognostic value of the necpal instrument palliative prognostic index and profund index in elderly residents of nursing homes with advanced chronic condition |
| topic | Palliative care Prognosis Nursing homes Frail elderly Aged Palliative medicine |
| url | https://doi.org/10.1186/s12877-023-04409-9 |
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