Mortality prediction with a geriatric vulnerability scale in the emergency department in a private hospital in Mexico City

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Coránguez-Capistrán, Alejandro R.O. Guzmán-Herrera, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6651544/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract PURPOSE The aim of this study was to translate, culturally adapt, and validate the acutely presenting older patient (APOP) screener into Spanish within the context of Mexican patients attending the emergency department to predict the risk of 90-day mortality. METHODS Patients older than 70 years from a cohort within a private hospital in Mexico City who received care in the emergency department were included. Translation, cultural adaptation, and validation were performed. For each patient, vulnerability risk was calculated, and a 90-day follow-up was conducted. RESULTS We achieved a successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. Ninety-day follow-up was completed in 206 patients. A high level of vulnerability on the scale (46 or more points) predicted mortality with a sensitivity of 51.6% and a specificity of 85.1%, area under the curve = 0.74 (95% CI; 0.71–0.77). CONCLUSION: The APOP scale helps to identify vulnerable Mexican older adults in the emergency department. Its high specificity allows identifying patients who likely do not require extensive evaluation, thus improving resource management and accelerating care in the time-sensitive emergency setting. Vulnerability geriatric Emergency Department mortality prediction Figures Figure 1 Key summary points Aim: To translate, culturally adapt, and validate the acutely presenting older patient (APOP) screener into Spanish within the context of Mexican patients attending the emergency department to predict the risk of 90-day mortality. Findings: We achieved a successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. A high level of vulnerability on the scale (46 or more points) predicted mortality with a sensitivity of 51.6% and a specificity of 85.1%, area under the curve = 0.74 (95% CI; 0.71-0.77). Message: Having a translated and validated vulnerability assessment tool for older adult emergency patients would optimize care and time management. Introduction Global aging perspective With the progress along the demographic transition, coupled with other societal developments, most countries have experienced declining fertility and improve mortality, marked by the elimination/reduction of many fatal infectious diseases that have prolonged life expectancy. Global life expectancy at birth reached 73 years in 2020, 7 more years than in 2000, and nearly 30 years more than in 1950. Consequently, the world's older adult population is expanding, with projections indicating that those aged 65 and over will comprise 15.9% of the global population by 2050 and 22.4% by 2100. This demographic shift is even more pronounced in several developed nations, where the proportion of elderly individuals is substantially higher ( 1 ). Latin America ranks as the second youngest region in the world; however, the ongoing inversion of the age structure in several countries is an issue demanding immediate attention from their governments ( 2 ). A changing age distribution carries significant social and economic implications, for example, in the allocation of resources like education, healthcare, and social security, which must be balanced between the needs of younger and older generations ( 3 ). Vulnerability in the geriatric patient The word “vulnerability” originates from the Latin word “vulnerabilis,” derived from “vulnerare,” meaning “to wound.” It is defined as an adjective signifying “susceptible to physical or emotional harm.” This susceptibility can trigger a cumulative escalation of negative impacts, potentially leading to severe or even fatal consequences ( 4 ). Notably, a defining feature of vulnerability is the limited capacity for immediate action to mitigate the situation. In the context of older adults, six dimensions of vulnerability have been identified and described as: physical, psychological, relational/interpersonal, moral, sociocultural, political and economic, and existential/spiritual ( 5 ). Senescence, the natural aging process involving a progressive decline in functional reserve, contributes to this vulnerability in older adults. Research highlights that age-related deterioration in physical and/or mental health, coupled with factors like cognitive deficits, psychological decline, falls, and frailty, are key contributors to vulnerability in this population. Assessing the vulnerability of geriatric patients in the Emergency Department Recognizing the increasing prevalence of older adults as the most rapidly expanding demographic in most countries, the International Federation of Emergency Medicine (IFEM) established a special interest group dedicated to geriatric emergency medicine in 2015( 6 ). Older patients frequently present with intricate care requirements, frailty, and a heightened susceptibility to adverse outcomes. Effective initial management and comprehensive assessment within the emergency department are essential for all patients, leading to substantial improvements in both immediate prognosis and the prevention of future morbidity, thereby fostering more efficient and effective healthcare services. Numerous screening scores have been developed to address the need to identify vulnerable older adults, some specifically for emergency medicine. However, despite considerable research efforts over the past decades, the utility of most of these screening tools remains imperfect. In October 2016, J. de Gelder and collaborators published a multivariable logistic regression analysis to estimate the regression coefficients of the Acutely Presenting Older Patient (APOP) prediction model for functional decline or 90-day mortality. Of the total sample, 9.9% of patients died within 90 days of attending the emergency department, obtaining an area under the curve result of 0.74 (95% CI; 0.71 to 0.77)( 7 , 8 ). Since geriatric vulnerability scales provide essential tools for evaluating the risk and needs of older adults and given the absence of scales specifically designed or adapted for the Mexican population, an adaptation is necessary to enhance assessment accuracy and inform the development of tailored interventions for our community. Adapting an existing geriatric vulnerability scale offers the opportunity to ensure its cultural and linguistic suitability for the Mexican population. This involves carefully adjusting the questions, assessment criteria, and weighing them to align with this population's specific characteristics and nuances. The aim of this study was evaluating the prognostic value for mortality of the APOP geriatric vulnerability scale in Mexican patients at 90 days from their admission to the emergency department. Methods Study design and participants A prospective, longitudinal, analytical, observational cohort study was conducted. The study included geriatric patients aged 70 years and above who presented for initial medical attention at the emergency service of the private hospital where the investigation was carried out, from January 2023 to December 2023. Inclusion criteria were: (i) geriatric patients aged 70 years or older, men or women, who present for emergency care for the first time during the study period; and (ii) all patients who understood and provided the informed consent. Exclusion criteria were: (i) patients for whom authorization to participate could not be obtained from their primary caregiver, (ii) patients whose condition required immediate resuscitation room attention, (iii) patients for whom accurate data collection was impossible due to a language barrier, and (iv)patients who left the waiting area before being attended to. Elimination criteria consisted of (i) patients from whom complete information could not be obtained during the survey and (ii) patients who refused to continue with the follow-up. The sample size for this study was calculated using the equation for one proportion estimation. A 95% confidence level was applied, corresponding to a Z-value of 1.96, to ensure the accuracy of the results. The expected proportion (P) of patients with high vulnerability who died within 90 days was estimated at 0.52, and the proportion of patients with low vulnerability who survived was also calculated ( 7 , 8 ). A margin of error of 8% was established. Applying these parameters to the formula, a sample size of 150 patients was needed to estimate sensitivity and 96 patients to estimate specificity with the desired precision. The present investigation followed the guidelines established by the World Medical Association's Declaration of Helsinki, the Nuremberg Code, and the Belmont Report. Furthermore, it fully complied with the provisions of the General Health Law regarding health research in Mexico. The study received ethical approval from the Research Ethics Committee (Protocol number 202307 approved in February 2023) and adhered to the sensitive data policy of the hospital where the research was conducted. Procedures for data gathering and follow-up Information gathering involved using a standardized form, administered through either patient interview (when feasible based on mental status) or interview with the primary caregiver. Follow-up for mortality status at 90 days was performed via telephone calls using the contact details provided at the time of enrollment. If the initial call was unanswered, a protocol of two additional daily calls for three consecutive days was implemented. Participants who could not be reached after these attempts were excluded from the final follow-up. APOP Questionnaire The original version of the APOP scale, was selected for this study, as published by its developers. The subsequent translation, cultural adaptation, and validation procedures were undertaken by the guidelines proposed by Beaton et al ( 9 ). Furthermore, the harmonization process, user testing phase, and final report preparation also incorporated the insights provided by Ortiz Gutiérrez et al ( 10 ). The scale translation was initiated by referencing the original APOP study and incorporating transcultural validation guidelines. A medical translation specialist was tasked with the primary translation to ensure a comprehensive approach, while a certified English translator without medical background concurrently performed a second independent translation. Based on the two initial translations, a final consensus translation of the scale was achieved through discussion among experts and study investigators. This final translated version underwent back-translation by a specialized English-speaking translator. A third native English-speaking translator subsequently validated the back-translated scale to confirm semantic equivalence. Expert validation and cultural equivalence Two expert panels were convened to ensure cultural equivalence and validate the final translation, each consisting of four healthcare professionals. Each panel included two specialists in emergency medicine, one in internal medicine, and one in geriatrics. These professionals were selected based on their academic qualifications, professional experience, and current board certification in their respective fields of specialization. The initial expert panel undertook an evaluation of cultural equivalence across four key dimensions: linguistic, semantic, conceptual, and practical and the other 4 experts performed the validation of logic, content, criterion, and construct. Statistical analysis Categorical data were analyzed using frequencies and percentages, with group comparisons performed via Chi-Squared or Fisher's exact tests. Normal distribution was assessed using the Kolmogorov-Smirnov test. Mean and standard deviation were reported for normally distributed continuous variables, and group differences were evaluated using the Student's t-test. Medians and interquartile ranges (25th-75th percentile) were presented for non-normally distributed continuous variables, and group comparisons were conducted using the Mann-Whitney U test. The individual probability of risk for each patient was estimated using the calculator APOP scale, based on a previously established logistic regression model ( 7 , 8 ) Following the findings reported from the prediction model, patients exhibiting a score of 46 points or greater were categorized as high vulnerability. The model's predictive performance was quantified using sensitivity and specificity, with observed 90-day mortality serving as the reference standard and the APOP vulnerability score acting as the predictor. Results Expert validation The expert validation assessment, comparing the original APOP scale with the final translated version (Table 1 ). The mean agreement was larger than 75% across all individual items and an overall average agreement larger than 80% (Table 2 ). Table 1 Final translation after expert validation and cultural adaptation, with original English language in italics. 1. Edad (Age) 2. Género ( Gender) Masculino ( Male ) Femenino ( Female ) 3. ¿El paciente llegó en ambulancia? ( Did the patient arrive by ambulance? ) Si ( Yes ) No ( No ) 4. Antes de la enfermedad o lesión que lo llevo a la sala de Urgencias, ¿Usted necesitaba… | ( Before the illness or injury that brought you to the ED, did you need… ) … ¿Alguien que lo ayude regularmente? | (Como tareas domésticas, preparación de comidas) 5. ( …Someone to help you on regular basis? (like housekeeping, preparing meals )) Si ( Yes ) No ( No ) 6. … ¿Asistencia para bañarse o ducharse? | ( …Assistance in bathing or showering? ) Si ( Yes ) No ( No ) 7. ¿Ha estado hospitalizado durante los últimos 6 meses? | ( Have you been hospitalized during the last 6 months? ) Si ( Yes ) No ( No ) 8. ¿El paciente tiene diagnóstico de demencia? | ( Is the patient diagnosed with dementia? ) Si ( Yes ) No ( No ) 9. Finalmente, quiero hacerte dos preguntas que ponen a prueba la cognición | ( Finally, I want to ask you two questions that test the cognition ) 10. ¿En qué año estamos? (Sólo el año exacto es correcto) | (( What year is it now? Only exact year is correct ) Correcto ( Right ) Incorrecto ( Wrong ) 11. Diga los meses en orden inverso (Diciembre-noviembre-octubre-septiembre-agosto-julio-junio-mayo-abril-marzo-febrero-enero) | (Say the months in reversed order) (dec-nov-oct-sep-aug-jul.jun-may-apr-feb-jan) Incorrecto cuando 2 o más estan incorrectos | ( Wrong when 2 or more incorrect) Correcto ( Right ) Incorrecto ( Wrong ) Table 2 Expert validation analysis for each item of the APOP scale. The agreement is expressed as percentage and was based on the assessment of four experts. logic, content, criterion, and construct. Item number Dimension Average Logic Content Criterion Construct 1 100% 100% 100% 100% 100% 2 100% 75% 75% 75% 81% 3 100% 100% 100% 100% 100% 4 100% 75% 100% 100% 94% 5 100% 100% 100% 100% 100% 6 100% 100% 100% 100% 100% 7 100% 100% 100% 100% 100% 8 100% 100% 100% 100% 100% 9 100% 100% 100% 100% 100% 10 100% 100% 100% 100% 100% 11 75% 100% 100% 100% 94% Description of participants A total of 317 patients were recruited. The 90-day follow-up was completed on 206 patients (65% of the initial sample of 317 enrolled participants). Patients were lost during follow-up (N = 111, 35% of the sample) due to challenges in contacting elderly participants via technology, inadequate family support networks, and changes in telephone numbers. Table 3 shows the participants baseline characteristics. Most patients had no multimorbidity (two or more conditions), although calf circumference measurements suggested sarcopenia (< 31 cm). No significant differences were observed in any demographic or clinical characteristics between the patients who completed the follow-up and those lost to follow-up. Table 3 Baseline characteristics of 317 elderly adults evaluated in the Emergency Department. Variable All (n = 317) Complete Follow-up (n = 206) Lost to Follow-up (n = 111) p-value Age (years) 81 (76–86) 81 (76–87) 81 (76–85) 0.441 # Sex Female 206 (65%) 140 (68%) 66 (60%) 0.175 & Male 111 (35%) 67 (32%) 44 (40%) Body Mass Index (kg/m 2 ) 25 (21.8–28.8) 24.9 (21.5–29.4) 25.1 (22.8–28) 0.930 # Calf Circumference (cm) 29 ( 24 – 32 ) 29 ( 25 – 32 ) 30 ( 23 – 33 ) 0.693 # Multi-morbidity 65 (21%) 47 (23%) 18 (16%) 0.183 & Polypharmacy 47 (15%) 33 (17%) 14 (13%) 0.381 & Hemoglobin (mg/dl) 13.28 (11.4–14.9) 13.35 (11.6–14.9) 131.10 (11.0–14.9) 0.699 # Albumin (g/dl) 3.84 (3.50–4.21) 3.95 (3.37–4.34) 3.77 (3.51–4.05) 0.184 # Total Cholesterol (mg/dl) 147.8 (117.3–183.5) 150.7 (120–186.7) 146 (109–171.8) 0.214 # Glucose (mg/dl) 111 (96.3–131.3) 112 (96–132) 107 (97–124) 0.393 # Total Lymphocyte Count (cells/mcl) 1.15 (0.81–1.66) 1.08 (0.79–1.57) 1.20 (0.83–1.72) 0.380 # Leukocytes (cells/mcl) 7.68 (5.65–10.65) 7.43 (5.65–10.97) 8.26 (5.69–9.66) 0.855 # Neutrophils (cells/mcl) 6.04 (4.13–10.09) 5.82 (4.06–11.22) 6.40 (4.61–8.26) 0.884 # Vulnerability (score) 23 (16–39) 24 (16–42) 22 (15–38) 0.336 # Vulnerability Level High Risk 63 (20%) 43 (21%) 20 (18%) 0.582 & Low Risk 254 (80%) 164 (79%) 90 (82%) Results expressed as median (25th percentile − 75th percentile) or as absolute value (percentage). Groups were compared using chi-square ( & ) or Mann-Whitney U test ( # ). Based on the patients with complete follow-up, an analysis of baseline characteristics stratified by 90-day survival status revealed significant differences between deceased and surviving patients (Table 4 ). Patients who died within the 90-day follow-up period exhibited a significantly higher mean age and lower mean hemoglobin levels. Furthermore, they demonstrated higher vulnerability scores. A greater proportion of the deceased group also presented with high vulnerability risk, cognitive impairment, dementia, ambulance arrival, and hospital admission. There are no significant differences between the other variables between groups. Table 4 Baseline Characteristics of 206 Older Adults Evaluated in the Emergency Department. Variable Survivors (n = 175) Non-Survivors (n = 31) p -value Age (years) 81 (75–85) 87 (79–92) < 0.001 Sex Female 119 (68%) 21 (68%) 0.977 # Male 56 (32%) 10 (32%) Body mass index (kg/m²) 25 (21.5–29.4) 28 (25.0–28.9) 0.970 # Calf Circumference (cm) 29 ( 25 – 32 ) 28 ( 25 – 31 ) 0.525 # Multi-morbidity 36 (21%) 11 (35%) 0.068 # Polypharmacy 26 (16%) 7 (23%) 0.301 # Hemoglobin (mg/dl) 13.4 (11.8–14. 9) 12.3 (10.6–13.7) 0.043 # Albumin (g/dl) 4.05 (3.58–4.34) 3.65 (3.30–4.24) 0.428 # Total Cholesterol (mg/dl) 149.8 (116.5–206.6) 166 (139.8–181.9) 0.397 # Glucose (mg/dl) 114.5 (97.4–134) 108 (89.9–127.8) 0.148 # Total Lymphocyte Count (cells/µL) 1.12 (0.82–1.56) 0.86 (0.52–1.60) 0.187 # Leukocytes (cells/µL) 7.46 (5.65–10.96) 7.67 (5.69–12.02) 0.581 # Neutrophils (cells/µL) 5.73 (4.03–10.09) 6.89 (4.39–14.01) 0.299 # Vulnerability (score) 22 (15–35) 46 (26–65) < 0.001 # Vulnerability Level High Risk 26 (15%) 16 (52%) < 0.001 & Low Risk 149 (85%) 15 (48%) Cognitive Impairment 20 (12%) 9 (30%) 0.013 & Dementia 9 (5%) 5 (16%) 0.041 & Arrival by Ambulance 18 (10%) 15 (48%) < 0.001 & Hospitalization 55 (31%) 19 (61%) 0.001 & Results are expressed as median (25th percentile − 75th percentile) or as absolute value (percentage). Groups were compared using chi-square ( & ) or Mann-Whitney U test ( # ). Mortality prediction The Receiver Operating Characteristic (ROC) curve analysis, (Fig. 1 ), indicated a notable predictive performance of the total APOP score for 90-day mortality. The area under the curve (AUC) was 0.783 (95% CI: 0.697–0.869), which was statistically significant (p < 0.001). Furthermore, the classification of high vulnerability (≥ 46 points) demonstrated a sensitivity of 51.6% and a specificity of 85.1% for predicting mortality. Discussion Main contribution This study's main contribution is the successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. This represents a significant milestone as the first global Spanish translation of the APOP scale and, to our understanding, the only vulnerability assessment tool to have undergone cultural equivalence assessment and expert validation. Introducing a Spanish-adapted vulnerability scale, specifically designed for older adults in the emergency setting, offers a practical tool for clinicians, facilitating more informed decision-making and improving the comprehensive care of these patients. The present research demonstrated the validated scale's ability to predict 90-day mortality in elderly individuals within the emergency department, with a sensitivity of 51.6% and a specificity of 85.1%. These results align with the findings reported by the original authors in the Dutch cohort (7,8). Comparison with previous studies The APOP screening instrument has not yet been compared in populations outside the Netherlands. However, within the Dutch population, it has been evaluated across various hospitals and settings. The Amsterdam Geriatric Emergency Medicine (AmsterGEM) study utilized a scale in two hospitals that was different from those in the original validation, including an academic hospital and a general hospital. This study reported an APOP sensitivity of 22% and a specificity of 94% for mortality, with an area under the ROC curve of 0.65 (95% CI 0.58-0.71). These findings differ from those observed in our population and the original study (11) . It has also been used in other contexts as a predictor of 30-day in-hospital mortality in hospitalized COVID-19 patients, showing an odds ratio (OR) of 1.6 (95% CI 1.0-2.6) for in-hospital mortality and an OR of 2.7 (95% CI 1.7-4.2) for 30-day mortality. However, it demonstrates poor discrimination for both in-hospital mortality, with an area under the curve (AUC) of 0.56 (95% CI 0.48-0.63), and for 30-day mortality, with an AUC of 0.62 (95% CI 0.55-0.68) (12). Beyond the APOP scale, alternative instruments for evaluating vulnerability in older adult patients within the emergency care context have been employed. Notably, in Thailand, research published in 2023 investigated vulnerability and mortality using the S TRIAGE scale, yielding an area under the receiver operating characteristic (ROC) curve of 0.826 (95% CI 0.773-0.879) (13) . Furthermore, systematic reviews and meta-analyses have been undertaken to evaluate the diagnostic accuracy of other geriatric vulnerability assessment tools, including the ISAR and TRST. A report published in 2017 detailed the diagnostic performance of these scales, indicating a sensitivity range of 67% to 99% and a specificity range of 21% to 41% for ISAR, whereas TRST exhibited a sensitivity between 52% and 75% and a specificity between 39% and 51% (14) . In Mexico, a study evaluated the social vulnerability index and mortality in geriatric populations, focusing on older adults who were not in the Emergency Department. The study found a correlation with prognostic value for mortality, with an AUC (Area Under the ROC Curve) of 0.659 (15). Interpretation of the APOP questionnaire items In the current study, mortality variables in geriatric patients were identified, consistent with prior findings in the medical literature, especially the original study that provided the foundation for this investigation. These factors include: Advanced Age: Increased age is associated with a higher risk of mortality in geriatric patients presenting to emergency departments. This is related to the natural aging process, even in healthy aging. Furthermore, the risk of chronic degenerative diseases, which increase allostatic load, rises with age (16–18). Ambulance Arrival: The need for ambulance transport to the hospital suggests a greater severity of the clinical condition and, consequently, a higher risk of fatal outcome. At the very least, mobility issues at the time of arrival indicate potentially unfavorable outcomes (19–21). Functional Dependence: Dependence in performing activities of daily living indicates a more precarious health status or diminished functional reserve, increasing vulnerability to acute events. As an individual's ability to independently perform basic activities of daily living decreases, their autonomy diminishes. This increasing dependence can create a significant burden for caregivers and family members. Consequently, the risk of reduced family and social support increases, which can negatively affect overall well-being (22–24). Previous Hospitalizations: A history of prior hospitalizations suggests a more compromised health background and a higher probability of complications and readmissions (25). Dementia: The presence of dementia is associated with an increased risk of mortality due to the greater frailty and comorbidities associated with this condition. It implies impaired communication and interaction with the environment. Additionally, the deterioration of cerebral mental functions characteristic of dementia can affect central nervous system regulatory mechanisms, compromising the function of other organs and systems (26–28). Gender: Previous studies have found that male gender is associated with a higher risk of mortality. For example, in older adults over 65 years of age in Spain admitted to the emergency service after an unintentional fall, the risk of mortality was higher in men than in women (29–31). However, the present study found no differences in the proportion of men and women between the group of patients who were alive at the end of follow-up and the group of patients who had died. This suggests that, in this population, the risk of mortality in older adults admitted to the emergency service appears to be more influenced by the environment and other factors. In addition to the APOP questionnaire variables, this study observed significant differences between the groups in serum hemoglobin levels, with lower levels in those who died than those who survived. However, it is essential to note that the lower hemoglobin level does not necessarily imply a higher prevalence of anemia at the time of the study. In older adults outside of the emergency department setting, anemia has been shown to increase the risk of all-cause and cause-specific mortality (32,33). A study in China showed that hemoglobin concentration was a predictor of mortality in older adults from regions with a high prevalence of longevity (34). The finding of lower hemoglobin levels among patients who died within 90 days of emergency department admission suggests that, even if patients do not have anemia at the time of admission, lower hemoglobin levels may be a potential risk factor for mortality. Clinical implications Having a translated and validated vulnerability assessment tool for older adult emergency patients would optimize care and time management. Its specificity would help differentiate patients who do not require comprehensive geriatric assessment and could potentially be managed through outpatient clinics, thereby secondarily alleviating the strain on emergency services, a significant current issue in the country that this tool aims to address, along with reducing unnecessary emergency department utilization. Study limitations This study was conducted at a single private hospital center. To enhance the generalizability of our findings, it is crucial to validate the performance of the APOP questionnaire, tailored for the Mexican population, across various public and private hospital settings. This study evaluated the APOP scale using the original equation parameters developed for the Dutch population. Modifications to these parameters to potentially improve scale performance were not explored, as they fell outside the scope of our study objectives. Conclusions The APOP scale helps to identify vulnerable older adults in the emergency department. Its strength lies in its high specificity, which allows identifying patients who likely do not require extensive evaluation, thus improving resource management and accelerating care in the time-sensitive emergency setting. Therefore, ongoing research and the adaptation of care methodologies and strategies are essential, alongside the dedicated allocation of financial resources to foster the development and implementation of integrated, high-quality care approaches for the elderly population. Declarations Acknowledgments We sincerely thank the original authors for their kind approval of the cultural adaptation and validation of APOP and to the patients and their families for their willingness to participate. 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Dintrans PV, Bautista EG. Functional Dependency in Mexico: Measurement Issues and Policy Challenges. Int J Health Policy Manag. 2022 Jul 1;11(7):1017–23. Yeh KP, Lin MH, Liu LK, Chen LY, Peng LN, Chen LK. Functional decline and mortality in long-term care settings: Static and dynamic approach. Journal of Clinical Gerontology and Geriatrics. 2014;5(1):13–7. Averin A, Shaff M, Weycker D, Lonshteyn A, Sato R, Pelton SI. Mortality and readmission in the year following hospitalization for pneumonia among US adults. Respir Med. 2021 Aug 1;185. Piovezan RD, Oliveira D, Arias N, Acosta D, Prince MJ, Ferri CP. Mortality Rates and Mortality Risk Factors in Older Adults with Dementia from Low-and Middle-Income Countries: The 10/66 Dementia Research Group Population-Based Cohort Study. Journal of Alzheimer’s Disease. 2020;75(2):581–93. Golüke NMS, Geerlings MI, van de Vorst IE, Vaartjes IH, de Jonghe A, Bots ML, et al. Risk factors of mortality in older patients with dementia in psychiatric care. Int J Geriatr Psychiatry. 2020 Feb 1;35(2):174–81. Bai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y. Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: A meta-analysis. J Orthop Surg Res. 2018 Nov 23;13(1). Crimmins EM, Shim H, Zhang YS, Kim JK. Differences between men and women in mortality and the health dimensions of the morbidity process. Vol. 65, Clinical Chemistry. American Association for Clinical Chemistry Inc.; 2019. p. 135–45. Yang J, Wu S, Liu Y, Jiang J, Chen S, Zhang B, et al. Gender disparities in all-cause mortality among individuals with early-onset cardiovascular diseases. BMC Public Health. 2024 Dec 1;24(1). Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, et al. The Association of Gender and Mortality in Geriatric Trauma Patients. Vol. 10, Healthcare (Switzerland). MDPI; 2022. Patel K V., Longo DL, Ershler WB, Yu B, Semba RD, Ferrucci L, et al. Haemoglobin concentration and the risk of death in older adults: Differences by race/ethnicity in the NHANES III follow-up. Br J Haematol. 2009 May;145(4):514–23. Zakai NA, French B, Arnold AM, Newman AB, Fried LF, Robbins J, et al. Hemoglobin decline, function, and mortality in the elderly: The cardiovascular health study. Am J Hematol. 2013 Jan;88(1):5–9. Ren J, Wang Z, Zhang Y, Zhang P, Zhou J, Zhong W, et al. Is Hemoglobin Concentration a Linear Predictor of Mortality in Older Adults From Chinese Longevity Regions? Front Public Health. 2021 Nov 29;9. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 02 Jul, 2025 Reviewers invited by journal 26 Jun, 2025 Editor assigned by journal 14 May, 2025 First submitted to journal 13 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6651544","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476870323,"identity":"91b4d5b0-f454-4aa2-84c3-919e8096f984","order_by":0,"name":"Roberto B. Coránguez-Capistrán","email":"","orcid":"","institution":"Anahuac University Mexico North: Universidad Anahuac Mexico","correspondingAuthor":false,"prefix":"","firstName":"Roberto","middleName":"B.","lastName":"Coránguez-Capistrán","suffix":""},{"id":476870324,"identity":"25c3a711-b63d-4838-a16b-448b56620840","order_by":1,"name":"Alejandro R.O. Guzmán-Herrera","email":"","orcid":"","institution":"Anahuac University Mexico North: Universidad Anahuac Mexico","correspondingAuthor":false,"prefix":"","firstName":"Alejandro","middleName":"R.O.","lastName":"Guzmán-Herrera","suffix":""},{"id":476870325,"identity":"7ac9c978-48e9-44aa-a86a-1db9cc12a9ca","order_by":2,"name":"Abel Lerma","email":"","orcid":"","institution":"UAEH: Universidad Autonoma del Estado de Hidalgo","correspondingAuthor":false,"prefix":"","firstName":"Abel","middleName":"","lastName":"Lerma","suffix":""},{"id":476870326,"identity":"7bf30cb3-0ef2-4e73-8a78-3a2d19a8efcf","order_by":3,"name":"Betzabeé Torres-Munguía","email":"","orcid":"","institution":"Anahuac University Mexico North: Universidad Anahuac Mexico","correspondingAuthor":false,"prefix":"","firstName":"Betzabeé","middleName":"","lastName":"Torres-Munguía","suffix":""},{"id":476870327,"identity":"2c836bac-c9f8-462a-9d6d-0ac7d32c858a","order_by":4,"name":"Raúl Zertuche-Calvillo","email":"","orcid":"","institution":"Anahuac University Mexico North: Universidad Anahuac Mexico","correspondingAuthor":false,"prefix":"","firstName":"Raúl","middleName":"","lastName":"Zertuche-Calvillo","suffix":""},{"id":476870328,"identity":"ec054748-1c52-4265-abe2-e05288d5fcf5","order_by":5,"name":"Adrián Ceballos-Bocanegra","email":"","orcid":"","institution":"Dalinde Medical Centre: Centro Medico Dalinde","correspondingAuthor":false,"prefix":"","firstName":"Adrián","middleName":"","lastName":"Ceballos-Bocanegra","suffix":""},{"id":476870329,"identity":"1842b879-bf91-49e0-9421-7d532048988c","order_by":6,"name":"Claudia Lerma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYDCCA0D8gIGBsY2BuQHElwMLPiCkJQGshRGsxRgsmECMlgaolkQwiU8L3+0DjB8Sag7L9rEfbHxcmWOXPj/s8EOgLXZyug3YtUieS2CWSDh22LiNJ7HZ8Oy25NyNt9MMgFqSjc0OYNdicIaBjSGB7XBiG0Nim2TjNubcjbMTQFoOJG7Dq+UfUAv/w/afjdvq0w1np38grCWxDahFIrGNsXHb4QR56Rz8tkieYWyWSOxLN26TeNgMdNhxww3SOQUHEgxw+4XvDPPBDx++WcvO708++LFxW7W8/Oz0zR8+VNjJ4dLCAI0OJKeCVRrgUo4NyDcQVDIKRsEoGAUjDAAAt2BnlVCf/5UAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-4679-7751","institution":"Ignacio Chavez National Institute for Cardiology: Instituto Nacional de Cardiologia Ignacio Chavez","correspondingAuthor":true,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Lerma","suffix":""}],"badges":[],"createdAt":"2025-05-13 05:16:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6651544/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6651544/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85830332,"identity":"0d6dcc8f-60a4-4311-b689-02ca5770f1f7","added_by":"auto","created_at":"2025-07-02 07:39:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20553,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of the APOP score obtained with the original model for predicting 90-day mortality in 206 older adults in the emergency department. Area under the curve (95% CI) = 0.783 (0.697 - 0.869), p \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6651544/v1/9071b8bc419e4a9d29052166.png"},{"id":85830429,"identity":"4ee93fc9-ec3e-41a6-9405-b43f932035b2","added_by":"auto","created_at":"2025-07-02 07:39:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":998621,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6651544/v1/5c2812da-c080-4f80-9bbd-1f70797bfb63.pdf"}],"financialInterests":"","formattedTitle":"Mortality prediction with a geriatric vulnerability scale in the emergency department in a private hospital in Mexico City","fulltext":[{"header":"Key summary points","content":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To translate, culturally adapt, and validate the acutely presenting older patient (APOP) screener into Spanish within the context of Mexican patients attending the emergency department to predict the risk of 90-day mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e We achieved a successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. A high level of vulnerability on the scale (46 or more points) predicted mortality with a sensitivity of 51.6% and a specificity of 85.1%, area under the curve = 0.74 (95% CI; 0.71-0.77).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage:\u003c/strong\u003e Having a translated and validated vulnerability assessment tool for older adult emergency patients would optimize care and time management.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eGlobal aging perspective\u003c/h2\u003e \u003cp\u003eWith the progress along the demographic transition, coupled with other societal developments, most countries have experienced declining fertility and improve mortality, marked by the elimination/reduction of many fatal infectious diseases that have prolonged life expectancy. Global life expectancy at birth reached 73 years in 2020, 7 more years than in 2000, and nearly 30 years more than in 1950. Consequently, the world's older adult population is expanding, with projections indicating that those aged 65 and over will comprise 15.9% of the global population by 2050 and 22.4% by 2100. This demographic shift is even more pronounced in several developed nations, where the proportion of elderly individuals is substantially higher (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLatin America ranks as the second youngest region in the world; however, the ongoing inversion of the age structure in several countries is an issue demanding immediate attention from their governments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A changing age distribution carries significant social and economic implications, for example, in the allocation of resources like education, healthcare, and social security, which must be balanced between the needs of younger and older generations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVulnerability in the geriatric patient\u003c/h2\u003e \u003cp\u003eThe word \u0026ldquo;vulnerability\u0026rdquo; originates from the Latin word \u0026ldquo;vulnerabilis,\u0026rdquo; derived from \u0026ldquo;vulnerare,\u0026rdquo; meaning \u0026ldquo;to wound.\u0026rdquo; It is defined as an adjective signifying \u0026ldquo;susceptible to physical or emotional harm.\u0026rdquo; This susceptibility can trigger a cumulative escalation of negative impacts, potentially leading to severe or even fatal consequences (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Notably, a defining feature of vulnerability is the limited capacity for immediate action to mitigate the situation. In the context of older adults, six dimensions of vulnerability have been identified and described as: physical, psychological, relational/interpersonal, moral, sociocultural, political and economic, and existential/spiritual (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Senescence, the natural aging process involving a progressive decline in functional reserve, contributes to this vulnerability in older adults. Research highlights that age-related deterioration in physical and/or mental health, coupled with factors like cognitive deficits, psychological decline, falls, and frailty, are key contributors to vulnerability in this population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessing the vulnerability of geriatric patients in the Emergency Department\u003c/h3\u003e\n\u003cp\u003eRecognizing the increasing prevalence of older adults as the most rapidly expanding demographic in most countries, the International Federation of Emergency Medicine (IFEM) established a special interest group dedicated to geriatric emergency medicine in 2015(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Older patients frequently present with intricate care requirements, frailty, and a heightened susceptibility to adverse outcomes. Effective initial management and comprehensive assessment within the emergency department are essential for all patients, leading to substantial improvements in both immediate prognosis and the prevention of future morbidity, thereby fostering more efficient and effective healthcare services. Numerous screening scores have been developed to address the need to identify vulnerable older adults, some specifically for emergency medicine. However, despite considerable research efforts over the past decades, the utility of most of these screening tools remains imperfect. In October 2016, J. de Gelder and collaborators published a multivariable logistic regression analysis to estimate the regression coefficients of the Acutely Presenting Older Patient (APOP) prediction model for functional decline or 90-day mortality. Of the total sample, 9.9% of patients died within 90 days of attending the emergency department, obtaining an area under the curve result of 0.74 (95% CI; 0.71 to 0.77)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince geriatric vulnerability scales provide essential tools for evaluating the risk and needs of older adults and given the absence of scales specifically designed or adapted for the Mexican population, an adaptation is necessary to enhance assessment accuracy and inform the development of tailored interventions for our community. Adapting an existing geriatric vulnerability scale offers the opportunity to ensure its cultural and linguistic suitability for the Mexican population. This involves carefully adjusting the questions, assessment criteria, and weighing them to align with this population's specific characteristics and nuances. The aim of this study was evaluating the prognostic value for mortality of the APOP geriatric vulnerability scale in Mexican patients at 90 days from their admission to the emergency department.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eA prospective, longitudinal, analytical, observational cohort study was conducted. The study included geriatric patients aged 70 years and above who presented for initial medical attention at the emergency service of the private hospital where the investigation was carried out, from January 2023 to December 2023. Inclusion criteria were: (i) geriatric patients aged 70 years or older, men or women, who present for emergency care for the first time during the study period; and (ii) all patients who understood and provided the informed consent.\u003c/p\u003e \u003cp\u003eExclusion criteria were: (i) patients for whom authorization to participate could not be obtained from their primary caregiver, (ii) patients whose condition required immediate resuscitation room attention, (iii) patients for whom accurate data collection was impossible due to a language barrier, and (iv)patients who left the waiting area before being attended to. Elimination criteria consisted of (i) patients from whom complete information could not be obtained during the survey and (ii) patients who refused to continue with the follow-up.\u003c/p\u003e \u003cp\u003eThe sample size for this study was calculated using the equation for one proportion estimation. A 95% confidence level was applied, corresponding to a Z-value of 1.96, to ensure the accuracy of the results. The expected proportion (P) of patients with high vulnerability who died within 90 days was estimated at 0.52, and the proportion of patients with low vulnerability who survived was also calculated (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A margin of error of 8% was established. Applying these parameters to the formula, a sample size of 150 patients was needed to estimate sensitivity and 96 patients to estimate specificity with the desired precision.\u003c/p\u003e \u003cp\u003e The present investigation followed the guidelines established by the World Medical Association's Declaration of Helsinki, the Nuremberg Code, and the Belmont Report. Furthermore, it fully complied with the provisions of the General Health Law regarding health research in Mexico. The study received ethical approval from the Research Ethics Committee (Protocol number 202307 approved in February 2023) and adhered to the sensitive data policy of the hospital where the research was conducted.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedures for data gathering and follow-up\u003c/h3\u003e\n\u003cp\u003eInformation gathering involved using a standardized form, administered through either patient interview (when feasible based on mental status) or interview with the primary caregiver. Follow-up for mortality status at 90 days was performed via telephone calls using the contact details provided at the time of enrollment. If the initial call was unanswered, a protocol of two additional daily calls for three consecutive days was implemented. Participants who could not be reached after these attempts were excluded from the final follow-up.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAPOP Questionnaire\u003c/h2\u003e \u003cp\u003eThe original version of the APOP scale, was selected for this study, as published by its developers. The subsequent translation, cultural adaptation, and validation procedures were undertaken by the guidelines proposed by Beaton et al (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Furthermore, the harmonization process, user testing phase, and final report preparation also incorporated the insights provided by Ortiz Guti\u0026eacute;rrez et al (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The scale translation was initiated by referencing the original APOP study and incorporating transcultural validation guidelines. A medical translation specialist was tasked with the primary translation to ensure a comprehensive approach, while a certified English translator without medical background concurrently performed a second independent translation.\u003c/p\u003e \u003cp\u003eBased on the two initial translations, a final consensus translation of the scale was achieved through discussion among experts and study investigators. This final translated version underwent back-translation by a specialized English-speaking translator. A third native English-speaking translator subsequently validated the back-translated scale to confirm semantic equivalence.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExpert validation and cultural equivalence\u003c/h3\u003e\n\u003cp\u003eTwo expert panels were convened to ensure cultural equivalence and validate the final translation, each consisting of four healthcare professionals. Each panel included two specialists in emergency medicine, one in internal medicine, and one in geriatrics. These professionals were selected based on their academic qualifications, professional experience, and current board certification in their respective fields of specialization. The initial expert panel undertook an evaluation of cultural equivalence across four key dimensions: linguistic, semantic, conceptual, and practical and the other 4 experts performed the validation of logic, content, criterion, and construct.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical data were analyzed using frequencies and percentages, with group comparisons performed via Chi-Squared or Fisher's exact tests. Normal distribution was assessed using the Kolmogorov-Smirnov test. Mean and standard deviation were reported for normally distributed continuous variables, and group differences were evaluated using the Student's t-test. Medians and interquartile ranges (25th-75th percentile) were presented for non-normally distributed continuous variables, and group comparisons were conducted using the Mann-Whitney U test.\u003c/p\u003e \u003cp\u003eThe individual probability of risk for each patient was estimated using the calculator APOP scale, based on a previously established logistic regression model (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Following the findings reported from the prediction model, patients exhibiting a score of 46 points or greater were categorized as high vulnerability. The model's predictive performance was quantified using sensitivity and specificity, with observed 90-day mortality serving as the reference standard and the APOP vulnerability score acting as the predictor.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExpert validation\u003c/h2\u003e \u003cp\u003eThe expert validation assessment, comparing the original APOP scale with the final translated version (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean agreement was larger than 75% across all individual items and an overall average agreement larger than 80% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal translation after expert validation and cultural adaptation, with original English language in italics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1. Edad (Age)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2.\u003c/em\u003e G\u0026eacute;nero (\u003cem\u003eGender)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e Masculino (\u003cem\u003eMale\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Femenino (\u003cem\u003eFemale\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3.\u003c/em\u003e \u0026iquest;El paciente lleg\u0026oacute; en ambulancia? (\u003cem\u003eDid the patient arrive by ambulance?\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Si (\u003cem\u003eYes\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e No (\u003cem\u003eNo\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4.\u003c/em\u003e Antes de la enfermedad o lesi\u0026oacute;n que lo llevo a la sala de Urgencias, \u0026iquest;Usted necesitaba\u0026hellip; | (\u003cem\u003eBefore the illness or injury that brought you to the ED, did you need\u0026hellip;\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026hellip; \u0026iquest;Alguien que lo ayude regularmente? | (Como tareas dom\u0026eacute;sticas, preparaci\u0026oacute;n de comidas) 5. (\u003cem\u003e\u0026hellip;Someone to help you on regular basis? (like housekeeping, preparing meals\u003c/em\u003e))\u003c/p\u003e \u003cp\u003e Si (\u003cem\u003eYes\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e No (\u003cem\u003eNo\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. \u0026hellip; \u0026iquest;Asistencia para ba\u0026ntilde;arse o ducharse? | (\u003cem\u003e\u0026hellip;Assistance in bathing or showering?\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Si (\u003cem\u003eYes\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e No (\u003cem\u003eNo\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. \u0026iquest;Ha estado hospitalizado durante los \u0026uacute;ltimos 6 meses? | (\u003cem\u003eHave you been hospitalized during the last 6 months?\u003c/em\u003e) \u003c/p\u003e \u003cp\u003e Si (\u003cem\u003eYes\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e No (\u003cem\u003eNo\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. \u0026iquest;El paciente tiene diagn\u0026oacute;stico de demencia? | (\u003cem\u003eIs the patient diagnosed with dementia?\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Si (\u003cem\u003eYes\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e No (\u003cem\u003eNo\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Finalmente, quiero hacerte dos preguntas que ponen a prueba la cognici\u0026oacute;n | (\u003cem\u003eFinally, I want to ask you two questions that test the cognition\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. \u0026iquest;En qu\u0026eacute; a\u0026ntilde;o estamos? (S\u0026oacute;lo el a\u0026ntilde;o exacto es correcto) | ((\u003cem\u003eWhat year is it now? Only exact year is correct\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Correcto (\u003cem\u003eRight\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Incorrecto (\u003cem\u003eWrong\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Diga los meses en orden inverso (Diciembre-noviembre-octubre-septiembre-agosto-julio-junio-mayo-abril-marzo-febrero-enero) | \u003cem\u003e(Say the months in reversed order) (dec-nov-oct-sep-aug-jul.jun-may-apr-feb-jan)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIncorrecto cuando 2 o m\u0026aacute;s estan incorrectos | (\u003cem\u003eWrong when 2 or more incorrect)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e Correcto (\u003cem\u003eRight\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e Incorrecto (\u003cem\u003eWrong\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpert validation analysis for each item of the APOP scale. The agreement is expressed as percentage and was based on the assessment of four experts. logic, content, criterion, and construct.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLogic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCriterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConstruct\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDescription of participants\u003c/h2\u003e \u003cp\u003eA total of 317 patients were recruited. The 90-day follow-up was completed on 206 patients (65% of the initial sample of 317 enrolled participants). Patients were lost during follow-up (N\u0026thinsp;=\u0026thinsp;111, 35% of the sample) due to challenges in contacting elderly participants via technology, inadequate family support networks, and changes in telephone numbers. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the participants baseline characteristics. Most patients had no multimorbidity (two or more conditions), although calf circumference measurements suggested sarcopenia (\u0026lt;\u0026thinsp;31 cm). No significant differences were observed in any demographic or clinical characteristics between the patients who completed the follow-up and those lost to follow-up.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of 317 elderly adults evaluated in the Emergency Department.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;317)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplete Follow-up (n\u0026thinsp;=\u0026thinsp;206)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLost to Follow-up (n\u0026thinsp;=\u0026thinsp;111)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (76\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (76\u0026ndash;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (76\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.441 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.175 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (21.8\u0026ndash;28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.9 (21.5\u0026ndash;29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.1 (22.8\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.930 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (\u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.693 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulti-morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.183 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolypharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.381 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.28 (11.4\u0026ndash;14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.35 (11.6\u0026ndash;14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131.10 (11.0\u0026ndash;14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.699 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.84 (3.50\u0026ndash;4.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.95 (3.37\u0026ndash;4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.77 (3.51\u0026ndash;4.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.184 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Cholesterol (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147.8 (117.3\u0026ndash;183.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150.7 (120\u0026ndash;186.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (109\u0026ndash;171.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.214 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (96.3\u0026ndash;131.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (96\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (97\u0026ndash;124)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.393 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Lymphocyte Count (cells/mcl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15 (0.81\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 (0.79\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.20 (0.83\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.380 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocytes (cells/mcl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.68 (5.65\u0026ndash;10.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.43 (5.65\u0026ndash;10.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.26 (5.69\u0026ndash;9.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.855 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils (cells/mcl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.04 (4.13\u0026ndash;10.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.82 (4.06\u0026ndash;11.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.40 (4.61\u0026ndash;8.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.884 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerability (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (16\u0026ndash;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (16\u0026ndash;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (15\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.336 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerability Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.582 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults expressed as median (25th percentile \u0026minus;\u0026thinsp;75th percentile) or as absolute value (percentage). Groups were compared using chi-square (\u003csup\u003e\u0026amp;\u003c/sup\u003e) or Mann-Whitney U test (\u003csup\u003e#\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eBased on the patients with complete follow-up, an analysis of baseline characteristics stratified by 90-day survival status revealed significant differences between deceased and surviving patients (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Patients who died within the 90-day follow-up period exhibited a significantly higher mean age and lower mean hemoglobin levels. Furthermore, they demonstrated higher vulnerability scores. A greater proportion of the deceased group also presented with high vulnerability risk, cognitive impairment, dementia, ambulance arrival, and hospital admission. There are no significant differences between the other variables between groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of 206 Older Adults Evaluated in the Emergency Department.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Survivors\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (75\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (79\u0026ndash;92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.977 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (21.5\u0026ndash;29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (25.0\u0026ndash;28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.970 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29 CR30\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.525 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulti-morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.068 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolypharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.301 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.4 (11.8\u0026ndash;14. 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3 (10.6\u0026ndash;13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.05 (3.58\u0026ndash;4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.65 (3.30\u0026ndash;4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.428 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Cholesterol (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149.8 (116.5\u0026ndash;206.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (139.8\u0026ndash;181.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.397 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.5 (97.4\u0026ndash;134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (89.9\u0026ndash;127.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.148 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Lymphocyte Count (cells/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12 (0.82\u0026ndash;1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86 (0.52\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocytes (cells/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.46 (5.65\u0026ndash;10.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.67 (5.69\u0026ndash;12.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.581 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils (cells/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.73 (4.03\u0026ndash;10.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.89 (4.39\u0026ndash;14.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.299 \u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerability (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (15\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (26\u0026ndash;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerability Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrival by Ambulance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001 \u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults are expressed as median (25th percentile \u0026minus;\u0026thinsp;75th percentile) or as absolute value (percentage). Groups were compared using chi-square (\u003csup\u003e\u0026amp;\u003c/sup\u003e) or Mann-Whitney U test (\u003csup\u003e#\u003c/sup\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMortality prediction\u003c/h2\u003e \u003cp\u003eThe Receiver Operating Characteristic (ROC) curve analysis, (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicated a notable predictive performance of the total APOP score for 90-day mortality. The area under the curve (AUC) was 0.783 (95% CI: 0.697\u0026ndash;0.869), which was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the classification of high vulnerability (\u0026ge;\u0026thinsp;46 points) demonstrated a sensitivity of 51.6% and a specificity of 85.1% for predicting mortality.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003ch2\u003eMain contribution\u003c/h2\u003e\n\u003cp\u003eThis study\u0026apos;s main contribution is the successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. This represents a significant milestone as the first global Spanish translation of the APOP scale and, to our understanding, the only vulnerability assessment tool to have undergone cultural equivalence assessment and expert validation. Introducing a Spanish-adapted vulnerability scale, specifically designed for older adults in the emergency setting, offers a practical tool for clinicians, facilitating more informed decision-making and improving the comprehensive care of these patients. The present research demonstrated the validated scale\u0026apos;s ability to predict 90-day mortality in elderly individuals within the emergency department, with a sensitivity of 51.6% and a specificity of 85.1%. These results align with the findings reported by the original authors in the Dutch cohort (7,8).\u003c/p\u003e\n\u003ch2 skip=\"true\"\u003eComparison with previous studies\u003c/h2\u003e\n\u003cp skip=\"true\"\u003eThe APOP screening instrument has not yet been compared in populations outside the Netherlands. However, within the Dutch population, it has been evaluated across various hospitals and settings. The Amsterdam Geriatric Emergency Medicine (AmsterGEM) study utilized a scale in two hospitals that was different from those in the original validation, including an academic hospital and a general hospital. This study reported an APOP sensitivity of 22% and a specificity of 94% for mortality, with an area under the ROC curve of 0.65 (95% CI 0.58-0.71). These findings differ from those observed in our population and the original study \u003cspan lang=\"EN-US\"\u003e(11)\u003c/span\u003e. It has also been used in other contexts as a predictor of 30-day in-hospital mortality in hospitalized COVID-19 patients, showing an odds ratio (OR) of 1.6 (95% CI 1.0-2.6) for in-hospital mortality and an OR of 2.7 (95% CI 1.7-4.2) for 30-day mortality. However, it demonstrates poor discrimination for both in-hospital mortality, with an area under the curve (AUC) of 0.56 (95% CI 0.48-0.63), and for 30-day mortality, with an AUC of 0.62 (95% CI 0.55-0.68) (12).\u003c/p\u003e\n\u003cp skip=\"true\"\u003eBeyond the APOP scale, alternative instruments for evaluating vulnerability in older adult patients within the emergency care context have been employed. Notably, in Thailand, research published in 2023 investigated vulnerability and mortality using the S TRIAGE scale, yielding an area under the receiver operating characteristic (ROC) curve of 0.826 (95% CI 0.773-0.879) \u003cspan lang=\"EN-US\"\u003e(13)\u003c/span\u003e. Furthermore, systematic reviews and meta-analyses have been undertaken to evaluate the diagnostic accuracy of other geriatric vulnerability assessment tools, including the ISAR and TRST. A report published in 2017 detailed the diagnostic performance of these scales, indicating a sensitivity range of 67% to 99% and a specificity range of 21% to 41% for ISAR, whereas TRST exhibited a sensitivity between 52% and 75% and a specificity between 39% and 51% \u003cspan lang=\"EN-US\"\u003e(14)\u003c/span\u003e. In Mexico, a study evaluated the social vulnerability index and mortality in geriatric populations, focusing on older adults who were not in the Emergency Department. The study found a correlation with prognostic value for mortality, with an AUC (Area Under the ROC Curve) of 0.659 (15).\u003c/p\u003e\n\u003ch2\u003eInterpretation of the APOP questionnaire items\u003c/h2\u003e\n\u003cp\u003eIn the current study, mortality variables in geriatric patients were identified, consistent with prior findings in the medical literature, especially the original study that provided the foundation for this investigation. These factors include:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAdvanced Age:\u003c/u\u003e\u003c/strong\u003e Increased age is associated with a higher risk of mortality in geriatric patients presenting to emergency departments. This is related to the natural aging process, even in healthy aging. Furthermore, the risk of chronic degenerative diseases, which increase allostatic load, rises with age (16\u0026ndash;18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAmbulance Arrival:\u003c/u\u003e\u003c/strong\u003e The need for ambulance transport to the hospital suggests a greater severity of the clinical condition and, consequently, a higher risk of fatal outcome. At the very least, mobility issues at the time of arrival indicate potentially unfavorable outcomes (19\u0026ndash;21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunctional Dependence:\u003c/u\u003e\u003c/strong\u003e Dependence in performing activities of daily living indicates a more precarious health status or diminished functional reserve, increasing vulnerability to acute events. As an individual\u0026apos;s ability to independently perform basic activities of daily living decreases, their autonomy diminishes. This increasing dependence can create a significant burden for caregivers and family members. Consequently, the risk of reduced family and social support increases, which can negatively affect overall well-being (22\u0026ndash;24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrevious Hospitalizations:\u003c/u\u003e\u003c/strong\u003e A history of prior hospitalizations suggests a more compromised health background and a higher probability of complications and readmissions (25).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDementia:\u003c/u\u003e\u003c/strong\u003e The presence of dementia is associated with an increased risk of mortality due to the greater frailty and comorbidities associated with this condition. It implies impaired communication and interaction with the environment. Additionally, the deterioration of cerebral mental functions characteristic of dementia can affect central nervous system regulatory mechanisms, compromising the function of other organs and systems (26\u0026ndash;28).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eGender:\u003c/u\u003e\u003c/strong\u003e Previous studies have found that male gender is associated with a higher risk of mortality. For example, in older adults over 65 years of age in Spain admitted to the emergency service after an unintentional fall, the risk of mortality was higher in men than in women (29\u0026ndash;31). However, the present study found no differences in the proportion of men and women between the group of patients who were alive at the end of follow-up and the group of patients who had died. This suggests that, in this population, the risk of mortality in older adults admitted to the emergency service appears to be more influenced by the environment and other factors.\u003c/p\u003e\n\u003cp\u003eIn addition to the APOP questionnaire variables, this study observed significant differences between the groups in serum hemoglobin levels, with lower levels in those who died than those who survived. However, it is essential to note that the lower hemoglobin level does not necessarily imply a higher prevalence of anemia at the time of the study. In older adults outside of the emergency department setting, anemia has been shown to increase the risk of all-cause and cause-specific mortality (32,33). A study in China showed that hemoglobin concentration was a predictor of mortality in older adults from regions with a high prevalence of longevity (34). The finding of lower hemoglobin levels among patients who died within 90 days of emergency department admission suggests that, even if patients do not have anemia at the time of admission, lower hemoglobin levels may be a potential risk factor for mortality.\u003c/p\u003e\n\u003ch2 skip=\"true\"\u003eClinical implications\u003c/h2\u003e\n\u003cp\u003eHaving a translated and validated vulnerability assessment tool for older adult emergency patients would optimize care and time management. Its specificity would help differentiate patients who do not require comprehensive geriatric assessment and could potentially be managed through outpatient clinics, thereby secondarily alleviating the strain on emergency services, a significant current issue in the country that this tool aims to address, along with reducing unnecessary emergency department utilization.\u003c/p\u003e\n\u003ch2\u003eStudy limitations\u003c/h2\u003e\n\u003cp\u003eThis study was conducted at a single private hospital center. To enhance the generalizability of our findings, it is crucial to validate the performance of the APOP questionnaire, tailored for the Mexican population, across various public and private hospital settings. This study evaluated the APOP scale using the original equation parameters developed for the Dutch population. Modifications to these parameters to potentially improve scale performance were not explored, as they fell outside the scope of our study objectives.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe APOP scale helps to identify vulnerable older adults in the emergency department. Its strength lies in its high specificity, which allows identifying patients who likely do not require extensive evaluation, thus improving resource management and accelerating care in the time-sensitive emergency setting. Therefore, ongoing research and the adaptation of care methodologies and strategies are essential, alongside the dedicated allocation of financial resources to foster the development and implementation of integrated, high-quality care approaches for the elderly population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the original authors for their kind approval of the cultural adaptation and validation of APOP and to the patients and their families for their willingness to participate. We also thank the Emergency Department staff for their readiness and cooperative attitude in supporting this study and the experts who contributed to the cultural adaptation and validation of APOP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflict of interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGu D, Andreev K, Dupre ME. Major Trends in Population Growth Around the World. 2021. \u003c/li\u003e\n\u003cli\u003eGuti\u0026eacute;rrez-Murillo RS. Population Aging in Latin America: A Salutogenic Understanding is Needed. Eur J Environ Public Health. 2022 Aug 9;6(2):em0121. \u003c/li\u003e\n\u003cli\u003eReijneveld SA. Age in epidemiological analysis. J Epidemiol Community Health (1978) [Internet]. 2003 Jun 1;57(6):397. Available from: http://jech.bmj.com/content/57/6/397.abstract\u003c/li\u003e\n\u003cli\u003eHardin SR. Vulnerability of older patients in critical care. Crit Care Nurse. 2015;35(3):55\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eSanchini V, Sala R, Gastmans C. The concept of vulnerability in aged care: a systematic review of argument-based ethics literature. BMC Med Ethics. 2022 Dec 1;23(1). \u003c/li\u003e\n\u003cli\u003eMagidson PD, Carpenter CR. Trends in Geriatric Emergency Medicine. Emerg Med Clin North Am. 2021 May 1;39(2):243\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eDe Gelder J, Lucke JA, De Groot B, Fogteloo AJ, Anten S, Mesri K, et al. Predicting adverse health outcomes in older emergency department patients: the APOP study. Netherlands; 2016 Oct. \u003c/li\u003e\n\u003cli\u003ede Gelder J, Lucke JA, Blomaard LC, Booijen AM, Fogteloo AJ, Anten S, et al. Optimization of the APOP screener to predict functional decline or mortality in older emergency department patients: Cross-validation in four prospective cohorts. Exp Gerontol. 2018 Sep 1;110:253\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, \u0026para;#\u0026sect;, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Vol. 25, SPINE. 2000. \u003c/li\u003e\n\u003cli\u003eOrtiz-Guti\u0026eacute;rrez S, Cruz-Avelar A. Translation and Cross-Cultural Adaptation of Health Assessment Tools. Actas Dermosifiliogr. 2018 Apr 1;109(3):202\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003evan Dam CS, Trappenburg MC, ter Wee MM, Hoogendijk EO, de Vet HC, Smulders YM, et al. The Accuracy of Four Frequently Used Frailty Instruments for the Prediction of Adverse Health Outcomes Among Older Adults at Two Dutch Emergency Departments: Findings of the AmsterGEM Study. Ann Emerg Med. 2021 Oct 1;78(4):538\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eSmits RAL, van Raaij BFM, Jansen SWM, van der Bol JM, van der Linden CMJ, Polinder-Bos HA, et al. Validation of the acutely presenting older patient screener for short term mortality prediction in older patients hospitalized for COVID-19. Eur Geriatr Med [Internet]. 2025 Apr 22; Available from: https://link.springer.com/10.1007/s41999-025-01200-4\u003c/li\u003e\n\u003cli\u003eSupatanakij P, Imok K, Suttapanit K. Screening Tool Risk Score Assessment in the Emergency Department for Geriatric (S-TRIAGE) in 28-day mortality. Int J Emerg Med. 2023 Dec 1;16(1). \u003c/li\u003e\n\u003cli\u003eRivero-Santana A, Del Pino-Sede\u0026ntilde;o T, Ramallo-Fari\u0026ntilde;a Y, Vergara I, Serrano-Aguilar P. Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis [Internet]. Vol. 29, Emergencias. 2017. Available from: http://formaciones.elmedicointeractivo.com/emer-\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez-Garrido N, Aguilar-Navarro SG, \u0026Aacute;vila-Funes JA, Theou O, Andrew M, P\u0026eacute;rez-Zepeda MU. The social vulnerability index, mortality and disability in mexican middle-aged and older adults. Geriatrics (Switzerland). 2021 Mar 1;6(1). \u003c/li\u003e\n\u003cli\u003eEbeling M, Rau R, Malmstr\u0026ouml;m H, Ahlbom A, Modig K. The rate by which mortality increase with age is the same for those who experienced chronic disease as for the general population. Age Ageing. 2021 Sep 1;50(5):1633\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eCrimmins EM, Johnston M, Hayward M, Seeman T. Age differences in allostatic load: An index of physiological dysregulation. In: Experimental Gerontology. Elsevier Inc.; 2003. p. 731\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eGuidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. Vol. 90, Psychotherapy and Psychosomatics. S. Karger AG; 2021. p. 11\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eJohansson F, Annerud C, Jensen ON, Lassen A. Patients arriving by ambulance to the Emergency Department; vital signs and 30 day mortality. Scand J Trauma Resusc Emerg Med. 2012 Dec;20(S2). \u003c/li\u003e\n\u003cli\u003ePetersen M, Kjeldtoft FG, Christensen EF, B\u0026oslash;ggild H, Lindskou TA. A classification system for identifying patients dead on ambulance arrival: a prehospital medical record review. Scand J Trauma Resusc Emerg Med. 2023 Dec 1;31(1). \u003c/li\u003e\n\u003cli\u003eBorg BA, Mosier JM. Mode of Arrival to the Emergency Department and Outcomes in Nontraumatic Critically Ill Adults. Vol. 3, Critical Care Explorations. Lippincott Williams and Wilkins; 2021. p. E0350. \u003c/li\u003e\n\u003cli\u003eLozano Keymolen D, Montoya Arce BJ, Gaxiola Robles Linares SC, Rom\u0026aacute;n S\u0026aacute;nchez YG. Dependencia funcional y su relaci\u0026oacute;n con la mortalidad general en adultos mayores. M\u0026eacute;xico: 2001-2015. Poblac Salud Mesoam. 2017 Dec 22;15(2). \u003c/li\u003e\n\u003cli\u003eDintrans PV, Bautista EG. Functional Dependency in Mexico: Measurement Issues and Policy Challenges. Int J Health Policy Manag. 2022 Jul 1;11(7):1017\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eYeh KP, Lin MH, Liu LK, Chen LY, Peng LN, Chen LK. Functional decline and mortality in long-term care settings: Static and dynamic approach. Journal of Clinical Gerontology and Geriatrics. 2014;5(1):13\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eAverin A, Shaff M, Weycker D, Lonshteyn A, Sato R, Pelton SI. Mortality and readmission in the year following hospitalization for pneumonia among US adults. Respir Med. 2021 Aug 1;185. \u003c/li\u003e\n\u003cli\u003ePiovezan RD, Oliveira D, Arias N, Acosta D, Prince MJ, Ferri CP. Mortality Rates and Mortality Risk Factors in Older Adults with Dementia from Low-and Middle-Income Countries: The 10/66 Dementia Research Group Population-Based Cohort Study. Journal of Alzheimer\u0026rsquo;s Disease. 2020;75(2):581\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eGol\u0026uuml;ke NMS, Geerlings MI, van de Vorst IE, Vaartjes IH, de Jonghe A, Bots ML, et al. Risk factors of mortality in older patients with dementia in psychiatric care. Int J Geriatr Psychiatry. 2020 Feb 1;35(2):174\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eBai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y. Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: A meta-analysis. J Orthop Surg Res. 2018 Nov 23;13(1). \u003c/li\u003e\n\u003cli\u003eCrimmins EM, Shim H, Zhang YS, Kim JK. Differences between men and women in mortality and the health dimensions of the morbidity process. Vol. 65, Clinical Chemistry. American Association for Clinical Chemistry Inc.; 2019. p. 135\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eYang J, Wu S, Liu Y, Jiang J, Chen S, Zhang B, et al. Gender disparities in all-cause mortality among individuals with early-onset cardiovascular diseases. BMC Public Health. 2024 Dec 1;24(1). \u003c/li\u003e\n\u003cli\u003ePandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, et al. The Association of Gender and Mortality in Geriatric Trauma Patients. Vol. 10, Healthcare (Switzerland). MDPI; 2022. \u003c/li\u003e\n\u003cli\u003ePatel K V., Longo DL, Ershler WB, Yu B, Semba RD, Ferrucci L, et al. Haemoglobin concentration and the risk of death in older adults: Differences by race/ethnicity in the NHANES III follow-up. Br J Haematol. 2009 May;145(4):514\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eZakai NA, French B, Arnold AM, Newman AB, Fried LF, Robbins J, et al. Hemoglobin decline, function, and mortality in the elderly: The cardiovascular health study. Am J Hematol. 2013 Jan;88(1):5\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eRen J, Wang Z, Zhang Y, Zhang P, Zhou J, Zhong W, et al. Is Hemoglobin Concentration a Linear Predictor of Mortality in Older Adults From Chinese Longevity Regions? Front Public Health. 2021 Nov 29;9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"internal-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iaem","sideBox":"Learn more about [Internal and Emergency Medicine](http://link.springer.com/journal/11739)","snPcode":"11739","submissionUrl":"https://www.editorialmanager.com/iaem/default.aspx","title":"Internal and Emergency Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Vulnerability, geriatric, Emergency Department, mortality prediction","lastPublishedDoi":"10.21203/rs.3.rs-6651544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6651544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePURPOSE\u003c/h2\u003e \u003cp\u003eThe aim of this study was to translate, culturally adapt, and validate the acutely presenting older patient (APOP) screener into Spanish within the context of Mexican patients attending the emergency department to predict the risk of 90-day mortality.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003ePatients older than 70 years from a cohort within a private hospital in Mexico City who received care in the emergency department were included. Translation, cultural adaptation, and validation were performed. For each patient, vulnerability risk was calculated, and a 90-day follow-up was conducted.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eWe achieved a successful validation by experts of a culturally adapted Spanish version of the APOP scale for Mexican patients. Ninety-day follow-up was completed in 206 patients. A high level of vulnerability on the scale (46 or more points) predicted mortality with a sensitivity of 51.6% and a specificity of 85.1%, area under the curve\u0026thinsp;=\u0026thinsp;0.74 (95% CI; 0.71\u0026ndash;0.77).\u003c/p\u003e\u003ch2\u003eCONCLUSION:\u003c/h2\u003e \u003cp\u003eThe APOP scale helps to identify vulnerable Mexican older adults in the emergency department. Its high specificity allows identifying patients who likely do not require extensive evaluation, thus improving resource management and accelerating care in the time-sensitive emergency setting.\u003c/p\u003e","manuscriptTitle":"Mortality prediction with a geriatric vulnerability scale in the emergency department in a private hospital in Mexico City","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 07:31:06","doi":"10.21203/rs.3.rs-6651544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-07-02T04:29:41+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-26T12:24:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-14T14:45:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Internal and Emergency Medicine","date":"2025-05-13T23:22:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"internal-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iaem","sideBox":"Learn more about [Internal and Emergency Medicine](http://link.springer.com/journal/11739)","snPcode":"11739","submissionUrl":"https://www.editorialmanager.com/iaem/default.aspx","title":"Internal and Emergency Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3bfa52e0-5158-4168-9912-f4ad6e9fe5ce","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T20:11:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 07:31:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6651544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6651544","identity":"rs-6651544","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}