Dataset Information

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

ABSTRACT:

Background

Screening for frailty might help to prevent adverse outcomes in hospitalised older adults.

Objective

To identify the most predictive and efficient screening tool for frailty.

Design and setting

Two consecutive observational prospective cohorts in four hospitals in the Netherlands.

Subjects

Patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.

Methods

Screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed.

Results

Follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58-0.66), but the percentage of positively screened patients (13-72%), sensitivity (24-89%) and specificity (35-91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70-80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort.

Conclusions

The VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.

SUBMITTER: Heim N

PROVIDER: S-EPMC4339728 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Publications

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

Heim Noor N van Fenema Ester M EM Weverling-Rijnsburger Annelies W E AW Tuijl Jolien P JP Jue Peter P Oleksik Anna M AM Verschuur Margot J MJ Haverkamp Jasper S JS Blauw Gerard Jan GJ van der Mast Roos C RC Westendorp Rudi G J RG

Age and ageing 20141128 2

<h4>Background</h4>Screening for frailty might help to prevent adverse outcomes in hospitalised older adults.<h4>Objective</h4>To identify the most predictive and efficient screening tool for frailty.<h4>Design and setting</h4>Two consecutive observational prospective cohorts in four hospitals in the Netherlands.<h4>Subjects</h4>Patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.<h4>Methods</h4>Screening instruments included in the Dutch Safety Management Programme [Veilighe ...[more]

PMID: 25432981

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Project description:BackgroundFrailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes.MethodsData was collected from a Geriatric Evaluation and Management Unit (GEMU) in Australia. Frailty was identified using Fried's frailty criteria. Psychosocial factors included wellbeing, sense of control (mastery), social activities, home/neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay (LOS), 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity.ResultsThe mean (SD) age of participants (n = 172) at admission was 85.2 (6.4) years, with 129 (75%) female patients. 96 (56%) patients were classified as frail, with 64 (37%) pre-frail and 12 (7%) robust. Frail patients had an increased likelihood of 12-month mortality (HR, 95% CI = 3.16, 1.36-7.33), discharge to a higher level of care (OR, 95% CI = 2.40, 1.21-4.78), long LOS (OR, 95% CI = 2.04, 1.07-3.88) and 1-month emergency rehospitalisation (OR, 95% CI = 2.53, 1.10-5.82). Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home/neighbourhood satisfaction.ConclusionsOur results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.

Project description:BackgroundPhysical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear.ObjectivesTo estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years.DesignProspective cohort study.SettingThe Health and Retirement Study (HRS).ParticipantsA total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014.MeasurementsThe five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status.ResultsThe prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001).ConclusionPhysical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function. J Am Geriatr Soc 67:477-483, 2019.

Dataset Information

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

Background

Objective

Design and setting

Subjects

Methods

Results

Conclusions

Publications

Optimal screening for increased risk for adverse outcomes in hospitalised older adults.

Similar Datasets

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