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Predicting functional adverse outcomes in hospitalized older patients: A systematic review of screening tools

  • Published:
The journal of nutrition, health & aging

Abstract

Background

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.

Objective

To identify instruments able to detect on admission older hospitalized patients at risk of functional decline at and after discharge.

Methods

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. independent epidemiologist assessed methodological quality of the retained articles.

Results

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 concerning reliability are often lacking. Operational characteristics are moderate (sensitivity 29–87%, negative likelihood ratio 0.2–0.8).

Conclusions

Instruments predicting functional adverse outcomes are difficult to compare due to heterogeneity of functional outcomes and hospital settings. The reason why so many tools have been developed is probably because none gives full satisfaction: their general predictive validity and performances are insufficient. Further research is needed to improve the screening of frail older patients admitted to hospital with standardized and validated tools.

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Authors and Affiliations

  1. Geriatric Department, UCLouvain, Cliniques Universitaires de Mont-Godinne, Rue du Dr Therasse, 1 - 5530, Yvoir, Belgique

    M. De Saint-Hubert, D. Schoevaerdts & C. Swine

  2. Bruxelles, Geriatric Department, UCLouvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10 - 1200, Bruxelles, Belgique

    P. Cornette & B. Boland

  3. UCLouvain, Public Health School, Clos Chapelle-aux-champs, 30 / 3037 - 1200, Bruxelles, Belgique

    W. D’Hoore

Authors
  1. M. De Saint-Hubert
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  2. D. Schoevaerdts
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  3. P. Cornette
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  4. W. D’Hoore
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  5. B. Boland
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  6. C. Swine
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Correspondence to M. De Saint-Hubert.

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De Saint-Hubert, M., Schoevaerdts, D., Cornette, P. et al. Predicting functional adverse outcomes in hospitalized older patients: A systematic review of screening tools. J Nutr Health Aging 14, 394–399 (2010). https://doi.org/10.1007/s12603-010-0086-x

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  • DOI: https://doi.org/10.1007/s12603-010-0086-x

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