Use of a Short-Form Screening Procedure to Detect Unrecognized Functional Disability in the Hospitalized Elderly (original) (raw)
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A patient-completed screening instrument for functional disability in the elderly
The American Journal of Medicine, 1991
PURPOSE: Although multidisciplinary geriatric assessment of elderly patients has been shown to be effective in identifying new diagnoses and previously unknown disabilities and in decreasing hospit~iiT~tion and mortality, time and financial constraints prevent most internists and office practitioners from using this approach with their older patients. Several instruments to screen older persons for functional disability have been proposed, but there are limited data regarding their utility or effectiveness in clinical medicine. This study developed a short, patient-completed screening assessment instrument (the Functional Assessment Screen), compared it to a standard, multi-disciplinery geriatric evaluation, and determined the screening instrument's ability to predict future use of home care services in a group of elderly patients. PATIENTS AND METHODS: The screening instrument was piloted retrospectively using data from patients seen in the previous 2 years at a hospital-based geriatrics clinic in Wisconsin. Using these results, a revised instrument was developed and mailed to 80 consecutive new patients who presented to the clinic for multi-disciplina~T geriatric assessment and primary care. These patients were interviewed 18 months later to determine use of home services, institutionaliT~tion, and death after the initial visit~ RESULTS: Fifty-eight of 80 eligible patients (72%) completed beth the clinic evaluation and 18-month follow-up. The patients were an elderly (mean age of 76), frail (average of three medical diagnoses), functionally disabled group (dependent in an average of 3.7 instrumental activities of d~ily living and 2.7 activities of daily
Journal of Clinical Nursing, 2010
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 preadmission 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 77AE6 years and 51AE7 % were male. Functional decline was found in 27AE8% of all patients. Sensitivity, specificity and area under receiver operating curve for identification of seniors at risk (ISAR) were 93, 39% and 0AE67, respectively. The corresponding results for the care complexity prediction instrument (COMPRI) were 70, 62% and 0AE69 and for the hospital admission risk profile (HARP) 21, 89% and 0AE56. 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.
The European Journal of Public Health, 2005
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 reassessed 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.
International Journal of Environmental Research and Public Health
Background: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk—Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d’ Evaluation du Risque de Perte d’Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. Methods: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily l...
The journal of nutrition, health & aging, 2010
Functional decline frequently occurs following hospitalisation in older people and may be prevented or minimized by specific management. Such care processes needs appropriate early screening of older hospitalized patients. To identify instruments able to detect on admission older hospitalized patients at risk of functional decline at and after discharge. Functional decline is defined as loss of independence in activities of daily living (functional decline) or admission in nursing home. The systematic search used Medline 1970-2007, Web of Science 1981-2007 and references list of relevant papers. An independent epidemiologist assessed methodological quality of the retained articles. We found 12 studies developing predictive tools, including 7145 patients. Functional outcomes were assessed at or after discharge. Preadmission functional status, cognition, and social support were major components for prediction of functional evolution. Few instruments are fully validated and data concer...
Quality of Life Research, 2004
The purpose of this study was to develop a scale that identifies hospitalized patients in need of physical therapy (PT) and/or occupational therapy (OT) assessments. Preliminary scale items were tested for reliability among 52 patients and remaining items were then administered to 299 patients and items that were associated with the concept of ‘need for an assessment’ on multivariate analyses were selected as final scale items. The concept of need was based on the clinical judgment of physical and occupational therapists. Receiver operator characteristic (ROC) curves were constructed to determine a cut-off score and the predictive ability of this score in determining length of stay and utilization of services was evaluated among 200 patients. The final scale contains two components. The PT component addresses ambulation, falls, breathing, and activities of daily living (ADL). The OT component addresses swallowing, ADL and instrumental activities of daily living (IADL). The area under the ROC curves of the PT and OT components were 0.71 and 0.72, respectively. Both components predicted length of stay and utilization (p < 0.05). In summary, this scale provides a mechanism for targeting patients for early PT and OT assessment and provides a basis for testing the effectiveness of early PT and OT interventions.