A clinical index to stratify hospitalized older adults according to risk for new-onset disability.
A clinical index to stratify hospitalized older adults according to risk for new-onset disability.
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DOI：
10.1111/j.1532-5415.2011.03409.x
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发表时间：
2011-07
影响因子：
6.3
通讯作者：
Landefeld CS
中科院分区：
文献类型：
--
作者：
Mehta KM;Pierluissi E;Boscardin WJ;Kirby KA;Walter LC;Chren MM;Palmer RM;Counsell SR;Landefeld CS
许多在住院前独立的老年人因出院而发展为新的残疾。早期对新发残疾进行风险分层可能会改善护理。因此，这项研究的目的是开发和验证一个临床指标，以确定入院时老年住院成年人出院时新发残疾的风险。数据分析来自两项前瞻性研究。俄亥俄州的两家教学医院。885名70岁及以上的患者从三级护理医院的普通医疗服务出院(平均年龄78岁，女性占59%)，753名患者从单独的社区教学医院出院(平均年龄79岁，女性占63%)。所有参与者报告在入院前2周在五项日常生活活动(ADL：洗澡、穿衣、转移、如厕和吃饭)中保持独立。新发残疾，定义为在入院前2周独立的参与者出院时在一个或多个ADL中需要个人帮助的新需求。对入院时已知的7个独立危险因素进行Logistic回归分析：年龄(80-，1分；≥90，2分)；基线时依赖3个或更多工具性ADL(2分)；基线时活动能力受损(不能跑步，1分；不能爬楼梯，2分)；入院时ADL依赖(2-3个ADL，1分；4-5个ADL，3分)；急性中风或转移性癌症(2分)；严重认知障碍(1分)；白蛋白低于3.0g/dL(2分)。新发残疾的发生率分别为6%、13%、18%、34%、35%、45%、50%和87%，得分分别为0、1、2、3、4、5、6和7分或以上，在派生队列中(受试者工作特征曲线下面积=0.784)，在验证队列中分别为8%、10%、27%、38%、44%、45%、58%和83%(Auc=0.784)。风险评分还预测(P<；.001)残疾严重程度、养老院安置和长期生存。这一临床指标决定了住院老年人新发残疾的风险，并可能为临床护理提供信息。
Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study’s objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge. Data analyses derived from two prospective studies. Two teaching hospitals in Ohio. Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission. New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission. Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80–89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2–3 ADLs, 1 point; 4–5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC) =0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC =0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival. This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.
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DOI：
10.1111/j.1532-5415.2000.tb03907.x
发表时间：
2000-02-01
影响因子：
6.3
作者：
Covinsky, KE;Palmer, RM;Chren, MM
通讯作者：
Chren, MM
DOI：
10.7326/0003-4819-139-5_part_2-200309021-00007
发表时间：
2003-09-02
影响因子：
39.2
作者：
Diehr, P;Patrick, DL
通讯作者：
Patrick, DL
影响因子：
4.8
作者：
Carlin, John B.;Galati, John C.;Royston, Patrick
通讯作者：
Royston, Patrick
影响因子：
--
作者：
Irwin, M;Artin, KHH;Oxman, MN
通讯作者：
Oxman, MN
影响因子：
5.7
作者：
Inouye, SK;Rushing, JT;Pompei, P
通讯作者：
Pompei, P