Detection of older people at increased risk of adverse health outcomes after an emergency visit:: The ISAR screening tool
Detection of older people at increased risk of adverse health outcomes after an emergency visit:: The ISAR screening tool
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DOI：
10.1111/j.1532-5415.1999.tb05204.x
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发表时间：
1999-10-01
影响因子：
6.3
通讯作者：
Ardman, O
中科院分区：
文献类型：
--
作者：
McCusker, J;Bellavance, F;Ardman, O
目的：开发一种自我报告筛查工具，以识别医院急诊科(ED)中有不良健康后果风险增加的老年人，包括：死亡、入院疗养院或长期住院，或临床上功能状态显著下降。设计：对65岁及以上的ED患者进行前瞻性(6个月)随访研究。集合：加拿大魁北克省蒙特利尔四家急诊医院的急诊科。PARTICANTS：社区居住的65岁及以上患者，在3个月的招募期间在工作日轮班来急诊科就诊。如果患者因为他们的身体状况或认知障碍而无法接受采访，并且没有其他信息来源，则排除他们。测量：在ED访问中确定的测量包括：27个关于社会、身体和精神风险因素的自我报告筛查问题；病史；医院服务的使用、药物和酒精的使用；以及较旧的美国资源和服务(OARS)日常生活活动(ADL)量表。结果：在完成随访措施的1673例患者中，488例(29.2%)有不良健康结局。量表的编制和选择方法包括Logistic回归、接受者操作特征曲线和专家判断。拟议的筛查工具(ISAR)包括六个自我报告问题，涉及功能依赖(病前和急性变化)、最近住院、记忆和视力受损以及多种药物。该工具在65岁及以上的总队列中表现良好，并在由倾向(从ED接纳或释放)、问卷管理语言(法语或英语)、信息来源(患者或其他)和其他特征定义的子组中表现良好。结论：ISAR是一种简短的自我报告问卷，可以快速识别ED中面临多种不良健康后果风险增加的老年患者和当前残疾的患者。
OBJECTIVES: To develop a self-report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long-term hospitalization, or a clinically significant decrease in functional status.DESIGN: Prospective (6-month) follow-up study of a cohort of ED patients aged 65 and older.SETTING: The EDs of four acute-care hospitals in Montreal, Quebec, Canada.PARTICIPANTS: Community-dwelling patients aged 65 and older who came to the EDs during the weekday shift over a 3-month recruitment period. Patients were excluded if they could not be interviewed either because of their medical condition or because of cognitive impairment and no other informant was available.MEASUREMENTS: Measures ascertained at the ED visit included: 27 self-report screening questions on social, physical, and mental risk factors; medical history; use of hospital services, medications, and alcohol; and the Older American Resources and Services (OARS) activities of daily living (ADL) scale. At follow-up, the OARS scale was readministered by telephone, and other adverse health outcomes were ascertained.RESULTS: Among 1673 patients who completed the follow-up measures, 488 (29.2%) had an adverse health outcome. Scale development and selection methods included logistic regression, receiver operating characteristic curves, and expert judgment. The proposed screening tool (ISAR) comprises six self-report questions on functional dependence (premorbid and acute change), recent hospitalization, impaired memory and vision, and polymedication. The tool performed well in the total cohort aged 65 and older, and in sub-groups defined by disposition (admitted or released from ED), language of questionnaire administration (French or English), information source (patient or other), and other characteristics.CONCLUSIONS: The ISAR is a short self-report questionnaire that can quickly identify older patients in the ED at increased risk of several adverse health outcomes and those with current disability.