Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool
Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool
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DOI：
10.1093/eurpub/cki054
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发表时间：
2006-04-01
影响因子：
4.4
通讯作者：
D'Hoore, W
中科院分区：
文献类型：
--
作者：
Cornette, P;Swine, C;D'Hoore, W
目的：开发一种预测工具，可在入院时用于识别出院后3个月有功能下降风险的老年住院患者。研究方法：这是一项前瞻性队列研究，纳入了625例年龄≥ 70岁（平均年龄80.0 ± 5.6岁）的患者，这些患者在两家学术医院急诊室住院至少48小时。出院后三个月，550名患者仍在进行分析。入院时采用日常生活活动量表（ADL）和工具性ADL量表对患者进行病前功能状态评估。收集了人口统计学和医学数据，包括认知功能、福尔斯、多种药物、合并症、瘫痪、活动性和自评健康状况。在出院时以及1个月和3个月后重新评估ADL功能。功能下降定义为在发病前和3个月评估之间ADL量表上至少损失一分。单变量分析用于选择与功能下降相关的变量。然后构建逻辑回归模型来预测出院后3个月的功能状态。结果：出院3个月后，165例（31.5%）患者出现了下降。预测工具SHERPA包括五个因素：年龄、病前工具性ADL受损、住院前一年内的福尔斯跌倒、认知功能障碍（简明简易精神状态低于15/21）和健康自评差。敏感性和特异性分别为67.9%和70.8%。结论：老年人在住院后功能下降的风险很高。入院时，一个简单的仪器可以很容易地识别这些患者，即使这个仪器的性能是中等的。
Objective: To develop a predictive tool that could be used on admission to identify older hospitalized people at risk of functional decline 3 months after discharge. Methods: This was a prospective cohort study that included 625 patients aged 70 years and older ( mean age 80.0 +/- 5.6 years) hospitalized by the way of the emergency room, for at least 48 h, in two academic hospitals. Three months after discharge, 550 patients remained for analysis. On admission, people were assessed for premorbid functional status with the activities of daily living (ADL) scale and instrumental ADL scale. Demographic and medical data, including cognitive function, falls, polypharmacy, comorbidity, continence, mobility and self-rated health, were collected. ADL functioning was re-assessed at discharge and 1 and 3 months later. Functional decline was defined as the loss of at least one point on the ADL scale between the premorbid and 3-month evaluation. Univariate analyses were used to select variables associated with functional decline. A logistic regression model was then constructed to predict functional status 3 months after discharge. Results: Three months after discharge, 165 (31.5%) patients had declined. The predictive tool SHERPA includes five factors: age, impairment in premorbid instrumental ADLs, falls in the year before hospitalization, cognitive impairment ( Abbreviated Mini Mental State below 15/21) and poor self-rated health. Sensitivity and specificity were 67.9% and 70.8%, respectively. Conclusions: Older people are at high risk of functional decline following hospitalization. On admission, a simple instrument can easily identify these patients, even though the performance of this instrument is moderate.