Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments
Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments
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DOI：
10.1111/j.1365-2702.2009.03035.x
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发表时间：
2010-05-01
影响因子：
4.2
通讯作者：
de Rooij, Sophia E.
中科院分区：
文献类型：
--
作者：
Hoogerduijn, Jita G.;Schuurmans, Marieke J.;de Rooij, Sophia E.
目的：通过比较以下三种筛查工具的预测值，建立一种筛查工具，用于识别老年住院患者的功能下降风险：老年人风险的识别，护理复杂性预测工具和住院风险概况背景：住院后，30-60%的老年患者的功能下降，设计：一项前瞻性队列研究。方法：纳入患者，年龄65岁及以上，急性入住一所大学教学医院的普通内科病房。在入院后48小时内，完成基线数据-人口统计学、认知、社会和入院前功能状态以及筛选工具。出院后3个月，通过电话访谈测量功能状态。Katz指数用于测量功能状态（6项活动）。功能下降被定义为在出院后三个月的Katz指数下降至少一个点相比，入院前states.Results.Included有177例患者，平均年龄为77中心点6年和51中心点7%是男性。功能减退27例，占8%。识别老年高危人群的敏感性、特异性和受试者工作曲线下面积（ISAR）分别为93、39%和0中心点67。护理复杂性预测工具（COMPRI）的相应结果为70、62%和0中心点69，入院风险评估工具（HARP）的相应结果为21、89%和0中心点56。住院风险状况显示结果最差。识别老年人的风险显示出最好的能力来预测这些患者的风险功能下降，似乎是最简单的工具在临床实践中。相关性临床实践。识别患者的风险功能下降是预防的第一步，其次是老年评估和有针对性的干预措施。在临床实践中实施之前，研究现有仪器的有效性是必要的。
Aims and objectives.To establish a screening instrument for identifying older hospitalised patients at risk for functional decline by comparing the predictive values of three screening instruments: identification of seniors at risk, care complexity prediction instrument and hospital admission risk profile.Background.After being hospitalised, 30-60% of older patients experience a decline in functioning, resulting in a decreased quality of life and autonomy.Design.A prospective cohort study.Methods.Included were patients, aged 65 years and older, acutely admitted to a general internal ward of a university teaching hospital. Within 48 hours after hospital admission, baseline data were completed - demographic, cognitive, social and pre-admission functional status and the screening instruments. Three months after discharge, functional status was measured by telephone interview. The Katz index was used to measure functional status (six activities). Functional decline was defined as a decline of at least one point on the Katz index at three months after discharge compared to pre-admission state.Results.Included were 177 patients; mean age was 77 center dot 6 years and 51 center dot 7 % were male. Functional decline was found in 27 center dot 8% of all patients. Sensitivity, specificity and area under receiver operating curve for identification of seniors at risk (ISAR) were 93, 39% and 0 center dot 67, respectively. The corresponding results for the care complexity prediction instrument (COMPRI) were 70, 62% and 0 center dot 69 and for the hospital admission risk profile (HARP) 21, 89% and 0 center dot 56.Conclusion.The discriminative values of both identification of seniors at risk and care complexity prediction instrument are fair. Hospital admission risk profile shows the poorest results. Identification of seniors at risk shows the best ability to predict those patients at risk for functional decline and seems to be the easiest instrument in clinical practice.Relevance to clinical practice.Identifying patients at risk for functional decline is a first step in prevention, followed by geriatric assessment and targeted interventions. Studying the validity of existing instruments is necessary before implementation in clinical practice.