The prediction of functional decline in older hospitalised patients
Open Access
- 28 February 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Age and Ageing
- Vol. 41 (3), 381-387
- https://doi.org/10.1093/ageing/afs015
Abstract
Background: thirty to sixty per cent of older patients experience functional decline after hospitalisation, associated with an increase in dependence, readmission, nursing home placement and mortality. First step in prevention is the identification of patients at risk. Objective: to develop and validate a prediction model to assess the risk of functional decline in older hospitalised patients. Design: development study: cohort study (n = 492). Validation study: secondary data analysis of a cohort study (n = 484) in an independent population. Both with follow-up after 3 months. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow-up compared with pre-admission status. Setting: development study: general internal medicine wards of two university hospitals and one regional hospital. Validation study: general internal wards of an university hospital. Subjects: patients ≥65 years acutely admitted and hospitalised for at least 48 h. Results: thirty-five per cent of all patients in the development cohort and 32% in the validation cohort developed functional decline. A four-item model could accurately predict functional decline with an AUC of 0.71. At threshold 2 sensitivity, specificity, positive and negative predictive values were 87, 39, 43 and 85%, respectively. In the validation study, this was, respectively, 0.68, 89, 41, 41 and 89%. Conclusion: pre-admission need for assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14, are the items of a prediction model to identify older patients at risk for functional decline following hospital admission. The strength of the model is that it relies on four simple questions and this makes it easy to use in clinical practice and easy to administer.This publication has 30 references indexed in Scilit:
- Functional Decline and Recovery of Activities of Daily Living in Hospitalized, Disabled Older Women: The Women's Health and Aging Study IJournal of the American Geriatrics Society, 2009
- The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community‐based, longitudinal studyJournal of Internal Medicine, 2009
- Functional Impact of 10 Days of Bed Rest in Healthy Older AdultsThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2008
- Comprehensive geriatric assessment for older hospital patientsBritish Medical Bulletin, 2005
- Designing Randomized, Controlled Trials Aimed at Preventing or Delaying Functional Decline and Disability in Frail, Older Persons: A Consensus ReportJournal of the American Geriatrics Society, 2004
- Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with AgeJournal of the American Geriatrics Society, 2003
- MODELS OF GERIATRICS PRACTICE; The Hospital Elder Life Program: A Model of Care to Prevent Cognitive and Functional Decline in Older Hospitalized PatientsJournal of the American Geriatrics Society, 2000
- Effects of Functional Status Changes Before and During Hospitalization on Nursing Home Admission of Older AdultsThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 1999
- Measuring prognosis and case mix in hospitalized elders. The importance of functional status.Journal of General Internal Medicine, 1997
- Risk Factors for Nursing Home Use After Hospitalization for Medical IllnessThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 1996