Abstract
Background and aims: Older hospitalized patients are at risk of functional decline, which is associated with several negative outcomes. The aim of this study was to compare the predictive accuracy of the Identification of Seniors At Risk (ISAR), Variable Indicative for Placement risk (VIP) and the Flemish version of the Triage Risk Screening Tool (TRST) in predicting functional decline. Methods: A prospective cohort study with 30 days follow-up in geriatric, medical and surgical wards in 25 hospitals was conducted. 752 participants aged 75 years or older were eligible for inclusion. Baseline data were gathered within 72 hours of admission. Functional decline was defined as an increase of one point or more from the premorbid Katz score to the score 30 days post-discharge. Positive predictive value (PPV) and negative predictive value (NPV) were calculated on 2×2 tables as well as by Bayes’ theorem. Results: Functional decline at 30 days postdischarge was observed in 279 participants (39%). ISAR and Flemish TRST showed high sensitivity (88%–78%) and fair NPV (62%–67%), but low specificity (19%–30%) and low PPV (47%–48%) using the original cut-off of ≥2. The sensitivity of VIP with cut-off ≥2 was too low (62%), but could be optimized with cut-off ≥1, showing sensitivity, specificity, PPV and NPV of 88%, 21%, 48% and 68%, respectively. Accuracy varied between 40% and 61% for all instruments on all calculated cut-offs. Conclusions: All three instruments performed similarly well, showing good sensitivity and fair NPV, the two major characteristics for good screening tools. False positives could be filtered out according to the clinical expert opinion of a care team.
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Cornette P, Swine C, Malhomme B, Gillet JB, 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 2005; 16: 203–8.
Creditor M. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118: 219–23.
Sager MA, Franke T, Inouye SK et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996; 156: 645–52.
Hoogerduijn JG, Schuurmans MJ, Duijnstee MSH, de Rooij SE, Grypdonck MF. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs 2005; 16: 46–57.
McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol 2002; 57A: M569–77.
Volpato S, Onder G, Cavalieri M et al. Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med 2007; 22: 668–74
Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc 1990; 38: 1296–303.
McCusker J, Bellavance F, Cardin S, Trépanier 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: 1229–37.
Vandewoude MF, Geerts CA, Paridaens KM, d’Hooghe AH. A screening tool for activating liaison geriatrics in general hospitals: the “Variable Indicative for Placement risk” (VIP). Eur J Geriatr 2008; 10: 120–6.
Kenis C, Geeraerts A, Braes T, Milisen K, Flamaing J, Wildiers H. The Flemish version of the Triage Risk Screening Tool (TRST): a multidimensional short screening tool for the assessment of elderly patients. Crit Rev Oncol Hematol 2006; 60 (Suppl 1): 31.
Braes T, Flamaing J, Sterckx W et al. Predicting the risk of functional decline in older patients admitted to the hospital: a comparison of three screening instruments. Age Ageing 2009; 38: 600–3.
Katz S, Akpom CA. Index of ADL. Med Care 1976; 14: 116–8.
McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol 2002; 57: M569–77.
Geyskens K, De Ridder K, Sabbe M et al. [Prediction of functional decline in elderly patients discharged from the accident and emergency department]. Tijdschr Gerontol Geriatr 2008; 39: 16–25 (article in Dutch).
Dendukuri N, McCusker J, Belzile E. The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc 2004; 52: 290–6.
Vandewoude MF, Geerts CA, d’Hooghe AH, Paridaens KM [A screening tool to identify older people at risk of adverse health outcomes at the time of hospital admission]. Tijdschr Gerontol Geriatr 2006; 37: 203–9 (article in Dutch).
Lee JS, Schwindt G, Langevin M et al. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Geriatr Soc 2008; 56: 1112–7.
Bayes T. An essay towards solving the problem of chances. Philos Trans 1763; 53: 376–418.
Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005; 71: 45–59.
Braes T, Flamaing J, Pelemans W et al. Geriatrics on the run: rationale, implementation, and preliminary findings of a Belgian internal liaison team. Acta Clin Belg 2009; 64: 384–92.
Braes T, Moons P, Lipkens P et al. Screening for risk of unplanned readmission in older patients admitted to the hospital: predictive accuracy of three instruments. Aging Clin Exp Res 2010, 22: 345–51.
Fan J, Worster A, Fernandes C. Predictive validity of the Triage Risk Screening Tool for elderly patients in a Canadian emergency department. Am J Emerg Med 2006; 24: 540–4.
Moons P, De Ridder K, Geyskens K et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14: 315–23.
Milisen K, Staelens N, Schwendimann R et al. Fall prediction in inpatients by bedside nurses using the St. Thomas’s Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument: a multicenter study. J Am Geriatr Soc 2007; 55: 725–33.
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Deschodt, M., Wellens, N.I.H., Braes, T. et al. Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Exp Res 23, 421–426 (2011). https://doi.org/10.1007/BF03325237
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DOI: https://doi.org/10.1007/BF03325237