Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Participants
2.2. Ethical Considerations
2.3. Data Collection
2.4. Measurement Instruments
2.4.1. Functional Status
2.4.2. Three Screening Instruments
2.5. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- McVey, L.J.; Becker, P.M.; Saltz, C.C.; Feussner, J.R.; Cohen, H.J. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann. Intern. Med. 1989, 110, 79–84. [Google Scholar] [CrossRef] [PubMed]
- Mahoney, J.E.; Sager, M.A.; Jalaluddin, M. Use of an ambulation assistive device predicts functional decline associated with hospitalization. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 1999, 54, M83-8. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sager, M.A.; Franke, T.; Inouye, S.K.; Landefeld, C.S.; Morgan, T.M.; Rudberg, M.A.; Siebens, H. Functional outcomes of acute medical illness and hospitalization in older persons. Arch. Intern. Med. 1996, 156, 645–652. [Google Scholar] [CrossRef] [PubMed]
- Alarcon, T.; Barcena, A.; Gonzalez-Montalvo, J.I.; Penalosa, C.; Salgado, A.L.B.E.R.T.O. Factors predictive of outcome on admission to an acute geriatric ward. Age Ageing 1999, 28, 429–432. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fortinsky, R.H.; Covinsky, K.E.; Palmer, R.M.; Landefeld, C.S. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 1999, 54, M521-6. [Google Scholar] [CrossRef] [PubMed]
- Martínez-Velilla, N.; Casas-Herrero, A.; Zambom-Ferraresi, F.; de Asteasu, M.L.S.; Lucia, A.; Galbete, A.; García-Baztán, A.; Alonso-Renedo, J.; González-Glaría, B.; Gonzalo-Lázaro, M.; et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern. Med. 2019, 179, 28–36. [Google Scholar] [CrossRef] [PubMed]
- Inouye, S.K.; Bogardus, S.T.; Baker, D.I.; Leo-Summers, L.; Cooney, L.M. The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J. Am. Geriatr. Soc. 2000, 48, 1697–1706. [Google Scholar]
- Hshieh, T.T.; Yang, T.; Gartaganis, S.L.; Yue, J.; Inouye, S.K. Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness. Am. J. Geriatr. Psychiatry 2018, 26, 1015–1033. [Google Scholar] [CrossRef]
- Lawton, M.P.; Brody, E.M. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9, 179–186. [Google Scholar] [CrossRef]
- Liebzeit, D.; King, B.; Bratzke, L. Measurement of function in older adults transitioning from hospital to home: An integrative review. Geriatr. Nurs. 2018, 39, 336–343. [Google Scholar] [CrossRef]
- Saint-Hubert, D.; Schoevaerdts, D.; Cornette, P.; d’Hoore, W.; Boland, B.; Swine, C. Predicting functional adverse outcomes in hospitalized older patients: A systematic review of screening tools. J. Nutr. Health Aging 2010, 14, 394–399. [Google Scholar] [CrossRef] [PubMed]
- Chen, B.; Covinsky, K.E.; Cenzer, I.S.; Adler, N.; Williams, B.A. Subjective social status and functional decline in older adults. J. Gen. Intern. Med. 2012, 27, 693–699. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ahmed, T.; Haboubi, N. Assessment and management of nutrition in older people and its importance to health. Clin. Interv. Aging 2010, 5, 207–216. [Google Scholar] [PubMed] [Green Version]
- Hoogerduijn, J.G.; Schuurmans, M.J.; Duijnstee, M.S.; De Rooij, S.E.; Grypdonck, M.F. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J. Clin. Nurs. 2007, 16, 46–57. [Google Scholar] [CrossRef] [PubMed]
- McCusker, J.; Bellavance, F.; Cardin, S.; Trepanier, S.; Verdon, J.; Ardman, O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: The ISAR screening tool. J. Am. Geriatr. Soc. 1999, 47, 1229–1237. [Google Scholar] [CrossRef]
- Meldon, S.W.; Mion, L.C.; Palmer, R.M.; Drew, B.L.; Connor, J.T.; Lewicki, L.J.; Bass, D.M.; Emerman, C.L. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad. Emerg. Med. 2003, 10, 224–232. [Google Scholar] [CrossRef]
- Vandewoude, M.F.J.; Geerts, C.A.M.; Paridaens, K.M.J.; d’Hooghe, H.M. A screening tool for activating liaison geriatrics in general hospitals: The Variable Indicative of Placement Risk (VIP). Eur. J. Geriatr. 2008, 10, 120–126. [Google Scholar]
- Hoogerduijn, J.G.; Buurman, B.M.; Korevaar, J.C.; Grobbee, D.E.; de Rooij, S.E.; Schuurmans, M.J. The prediction of functional decline in older hospitalised patients. Age Ageing 2012, 41, 381–387. [Google Scholar] [CrossRef] [Green Version]
- Sager, M.A.; Rudberg, M.A.; Jalaluddin, M.; Franke, T.; Inouye, S.K.; Landefeld, C.S.; Siebens, H.; Winograd, C.H. Hospital admission risk profile (HARP): Identifying older patients at risk for functional decline following acute medical illness and hospitalization. J. Am. Geriatr. Soc. 1996, 44, 251–257. [Google Scholar] [CrossRef]
- Huyse, F.J.; De Jonge, P.; Slaets, J.P.; Herzog, T.; Lobo, A.; Lyons, J.S.; Opmeer, B.C.; Stein, B.; Arolt, V.; Balogh, N.; et al. COMPRI—An instrument to detect patients with complex care needs: Results from a European study. Psychosomatics 2001, 42, 222–228. [Google Scholar] [CrossRef]
- Cornette, P.; Swine, C.; Malhomme, B.; Gillet, J.B.; Meert, P.; D’Hoore, W. Early evaluation of the risk of functional decline following hospitalization of older patients: Development of a predictive tool. Eur. J. Public Health 2006, 16, 203–208. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Deschodt, M.; Wellens, N.I.; Braes, T.; De Vuyst, A.; Boonen, S.; Flamaing, J.; Moons, P.; Milisen, K. Prediction of functional decline in older hospitalized patients: A comparative multicenter study of three screening tools. Aging Clin. Exp. Res. 2011, 23, 421–426. [Google Scholar] [CrossRef]
- Braes, T.; Flamaing, J.; Sterckx, W.; Lipkens, P.; Sabbe, M.; de Rooij, S.E.; Schuurmans, M.J.; Moons, P.; Milisen, K. Predicting the risk of functional decline in older patients admitted to the hospital: A comparison of three screening instruments. Age Ageing 2009, 38, 600–603. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mahoney, F.I.; Barthel, D.W. Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md. State Med. J. 1965, 14, 61–65. [Google Scholar]
- Minosso, J.S.M.; Amendola, F.; Alvarenga, M.R.M.; Oliveira, M.A.D.C. Validation of the Barthel Index in elderly patients attended in outpatient clinics, in Brazil. Acta Paul. Enferm. 2010, 23, 218–223. [Google Scholar] [CrossRef]
- Gosman-Hedström, G.; Svensson, E. Parallel reliability of the functional independence measure and the Barthel ADL index. Disabil. Rehabil. 2000, 22, 702–715. [Google Scholar] [CrossRef]
- Weinberger, M.; Samsa, G.P.; Schmader, K.; Greenberg, S.M.; Carr, D.B.; Wildman, D.S. Comparing proxy and patients’ perceptions of patients’ functional status: Results from an outpatient geriatric clinic. J. Am. Geriatr. Soc. 1992, 40, 585–588. [Google Scholar] [CrossRef] [PubMed]
- Youden, W.J. Index for rating diagnostic tests. Cancer 1950, 3, 32–35. [Google Scholar] [CrossRef]
- Zisberg, A.; Shadmi, E.; Gur-Yaish, N.; Tonkikh, O.; Sinoff, G. Hospital-associated functional decline: The role of hospitalization processes beyond individual risk factors. J. Am. Geriatr. Soc. 2015, 63, 55–62. [Google Scholar] [CrossRef]
- Chen, C.C.; Wang, C.; Huang, G.H. Functional trajectory 6 months posthospitalization: A cohort study of older hospitalized patients in Taiwan. Nurs. Res. 2008, 57, 93–100. [Google Scholar] [CrossRef]
- Tavares, J.P.D.A.; Nunes, L.A.N.V.; Grácio, J.C.G. Hospitalized older adult: Predictors of functional decline. Rev. Lat.-Am. Enferm. 2021, 29, e3399. [Google Scholar] [CrossRef] [PubMed]
- Pearman, A.; Storandt, M. Self-discipline and self-consciousness predict subjective memory in older adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 2005, 60, P153-7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Creditor, M.C. Hazards of hospitalization of the elderly. Ann. Intern. Med. 1993, 118, 219–223. [Google Scholar] [CrossRef] [PubMed]
- De Gelder, J.; Haenen, E.; Lucke, J.A.; Klop, H.G.; Blomaard, L.C.; Smit, R.A.J.; Mesri, K.; de Groot, B.; Fogteloo, A.J.; Anten, S.; et al. Optimising the ISAR-HP to screen efficiently for functional decline in older patients. Neth. J. Med. 2017, 75, 379–385. [Google Scholar] [PubMed]
- Linden, A. Measuring diagnostic and predictive accuracy in disease management: An introduction to receiver operating characteristic (ROC) analysis. J. Eval. Clin. Pract. 2006, 12, 132–139. [Google Scholar] [CrossRef]
- Hoogerduijn, J.G.; de Rooij, S.E.; Grobbee, D.E.; Schuurmans, M.J. Predicting functional decline in older patients undergoing cardiac surgery. Age Ageing 2014, 43, 218–221. [Google Scholar] [CrossRef] [Green Version]
- De Brauwer, I.; Cornette, P.; Boland, B.; Verschuren, F.; D’Hoore, W. Can we predict functional decline in hospitalized older people admitted through the emergency department? Reanalysis of a predictive tool ten years after its conception. BMC Geriatr. 2017, 17, 105. [Google Scholar] [CrossRef] [Green Version]
Variables | All (N = 197) | Without Functional Decline (n = 120) | Functional Decline (n = 77) | p | |||
---|---|---|---|---|---|---|---|
n (%) | M ± SD | n (%) | M ± SD | n (%) | M ± SD | ||
Gender | 0.849 b | ||||||
Males | 93 (47.2) | 56 (46.6) | 37 (48.0) | ||||
Females | 104 (52.7) | 64 (53.4) | 40 (52.0) | ||||
Age (years) | 77.7 | 76.52 ± 7.19 | 78.9 ± 6.85 | 0.021 a,* | |||
65–74 | 73 (37.0) | 51 (42.5) | 22 (28.5) | 0.132 b | |||
75–84 | 90 (45.6) | 51 (42.5) | 39 (50.7) | ||||
≥85 | 34 (17.2) | 18 (15.0) | 16 (20.8) | ||||
Education level | 0.562 b | ||||||
Illiterate | 75 (38.0) | 41 (34.1) | 34 (44.2) | ||||
Elementary school | 97 (49.2) | 62 (51.6) | 35 (45.4) | ||||
Junior high school and above | 25 (12.6) | 17 (14.1) | 8 (10.4) | ||||
Marital status | 0.287 b | ||||||
Single | 5 (2.5) | 5 (4.1) | 0 (0.0) | ||||
Married | 145 (73.6) | 88 (73.3) | 57 (74.1) | ||||
Widowed | 42 (21.3) | 25 (20.8) | 17 (22.1) | ||||
Divorced | 5 (2.5) | 2 (1.6) | 3 (3.8) | ||||
Caregiver | 0.102 b | ||||||
Him or herself | 24 (12.1) | 20 (16.6) | 4 (5.2) | ||||
Family members | 134 (68.0) | 79 (65.8) | 55 (71.4) | ||||
Nurse aides | 39 (19.7) | 21 (17.5) | 18 (23.4) | ||||
Admitted from | 0.770 b | ||||||
ER | 143 (72.5) | 88 (73.3) | 55 (71.4) | ||||
OPD | 54 (27.4) | 32 (26.7) | 22 (28.6) | ||||
Polypharmacy ≥5 | 0.060 b | ||||||
No | 111 (56.3) | 74 (61.6) | 37 (48.1) | ||||
Yes | 86 (43.6) | 46 (38.4) | 40 (51.9) | ||||
Barthel Index | |||||||
First assessment | 83.5 | 85.29 ± 23.0 | 81.88 ± 20.80 | 0.284 a | |||
Second assessment | 77.4 | 85.29 ± 23.0 | 69.48 ± 21.14 | <0.001 a,*** | |||
MMSE 1 | 14.33 ± 3.35 | 12.77 ± 3.02 | <0.001 a,*** | ||||
0–14 (impaired cognition) | 109 (55.3) | 55 (45.8) | 54 (70.1) | <0.001 b,*** | |||
≥15 (normal cognition) | 88 (44.6) | 65 (54.2) | 23 (29.9) | ||||
Perception of poor health | |||||||
No | 77 (39.0) | 68 (56.7) | 9 (11.7) | <0.001 b,*** | |||
Yes | 120 (60.9) | 52 (43.3) | 68 (88.3) | ||||
Length of hospital stay (days) | 6.5 | 6.39 ± 4.99 | 6.6 ± 3.27 | 0.727 a |
Original Cut-Off Points | Sensitivity (%) | Specificity (%) | Youden’s Index | The Best Cutoff Point | AUC (95% CI) | |
---|---|---|---|---|---|---|
ISAR-HP 1 | Total Score: 5 ≥2: risk | 96.1 | 52.5 | 0.486 | 2.5 | 0.751 (0.684–0.818) |
VIP 2 | Total Score: 4 0–2: low risk 3–4: increased risk | 83.1 | 62.5 | 0.456 | 1.5 | 0.761 (0.695–0.826) |
SHERPA 3 | Total Score 11.5 0–3: low risk 3.5–4.5: mild risk 5–6: moderate risk >6: high risk | 89.6 | 54.2 | 0.438 | 4.75 | 0.758 (0.692–0.823) |
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Wang, M.-C.; Liao, W.-C.; Lee, K.-C.; Lu, S.-H.; Lin, Y.-P. Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients. Int. J. Environ. Res. Public Health 2022, 19, 6685. https://doi.org/10.3390/ijerph19116685
Wang M-C, Liao W-C, Lee K-C, Lu S-H, Lin Y-P. Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients. International Journal of Environmental Research and Public Health. 2022; 19(11):6685. https://doi.org/10.3390/ijerph19116685
Chicago/Turabian StyleWang, Mei-Chun, Wen-Chun Liao, Kwo-Chen Lee, Shu-Hua Lu, and Yun-Ping Lin. 2022. "Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients" International Journal of Environmental Research and Public Health 19, no. 11: 6685. https://doi.org/10.3390/ijerph19116685