Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Abstract Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), and signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61), cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

10.21203/rs.2.16667/v1 ◽

2019 ◽

Author(s):

Anne-Carina Scharf ◽

Janine Gronewold ◽

Christian Dahlmann ◽

Jeanina Schlitzer ◽

Andreas Kribben ◽

...

Keyword(s):

At Risk ◽

Hospital Stay ◽

Older Patients ◽

Functional Decline ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Clinical Patient ◽

Medical Needs ◽

Patients At Risk ◽

Cognition Impairment

Abstract Background : The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods : 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, ISAR score and CGA results with length of hospital stay and number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61) cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion : Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

BMC Geriatrics ◽

10.1186/s12877-020-1443-1 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anne-Carina Scharf ◽

Janine Gronewold ◽

Christian Dahlmann ◽

Jeanina Schlitzer ◽

Andreas Kribben ◽

...

Keyword(s):

At Risk ◽

Older Patients ◽

Functional Decline ◽

Patient Characteristics ◽

Medical Needs ◽

Patients At Risk

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Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

ERJ Open Research ◽

10.1183/23120541.00034-2015 ◽

2016 ◽

Vol 2 (1) ◽

pp. 00034-2015 ◽

Cited By ~ 17

Author(s):

Mamta Ruparel ◽

Jose Luis López-Campos ◽

Ady Castro-Acosta ◽

Sylvia Hartl ◽

Francisco Pozo-Rodriguez ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Clinical Severity ◽

Chronic Obstructive ◽

Cluster Effect ◽

Obstructive Pulmonary Disease ◽

Targeted Interventions ◽

Hospitalised Patients ◽

Patients At Risk

Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1996.tb00910.x ◽

1996 ◽

Vol 44 (3) ◽

pp. 251-257 ◽

Cited By ~ 248

Author(s):

Mark A. Sager ◽

Mark A. Rudberg ◽

Muhammad Jalaluddin ◽

Todd Franke ◽

Sharon K. Inouye ◽

...

Keyword(s):

At Risk ◽

Hospital Admission ◽

Older Patients ◽

Functional Decline ◽

Risk Profile ◽

Medical Illness ◽

Patients At Risk

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God Bless You? The Association of Religion and Spirituality with Reduction of Suicide Ideation and Length of Hospital Stay among Psychiatric Patients at Risk for Suicide

Suicide and Life-Threatening Behavior ◽

10.1111/sltb.12582 ◽

2019 ◽

Vol 50 (1) ◽

pp. 95-110

Author(s):

Martin Plöderl ◽

Sabine Kunrath ◽

Clemens Fartacek

Keyword(s):

At Risk ◽

Hospital Stay ◽

Suicide Ideation ◽

Psychiatric Patients ◽

Length Of Hospital Stay ◽

Religion And Spirituality ◽

Patients At Risk

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The neuropathogenesis of delirium

Reviews in Clinical Gerontology ◽

10.1017/s0959259802012182 ◽

2002 ◽

Vol 12 (1) ◽

pp. 62-67 ◽

Cited By ~ 11

Author(s):

Susan White

Keyword(s):

Hospital Stay ◽

Older Patients ◽

Independent Predictor ◽

Length Of Hospital Stay ◽

Predisposing Factors ◽

Advanced Age ◽

Major Surgery ◽

Common Disorder ◽

Disturbance Of Consciousness ◽

Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

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Preventable hospitalizations among older patients with cognitive impairments and dementia

International Psychogeriatrics ◽

10.1017/s1041610218000960 ◽

2018 ◽

Vol 31 (3) ◽

pp. 383-391 ◽

Cited By ~ 7

Author(s):

Dominik Wolf ◽

Carolin Rhein ◽

Katharina Geschke ◽

Andreas Fellgiebel

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Ambulatory Care ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Older Patients ◽

Hospital Admissions ◽

Cognitive Impairments ◽

Length Of Hospital Stay ◽

Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

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Real-time utilisation of administrative data in the ED to identify older patients at risk: development and validation of the Dynamic Silver Code

BMJ Open ◽

10.1136/bmjopen-2019-033374 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033374 ◽

Cited By ~ 2

Author(s):

Daniela Balzi ◽

Giulia Carreras ◽

Francesco Tonarelli ◽

Luca Degli Esposti ◽

Paola Michelozzi ◽

...

Keyword(s):

At Risk ◽

Cohort Study ◽

Real Time ◽

Administrative Data ◽

Older Patients ◽

Clinical Decision Making ◽

External Validation ◽

Clinical Decision ◽

Patients At Risk ◽

Ed Visits

ObjectiveIdentification of older patients at risk, among those accessing the emergency department (ED), may support clinical decision-making. To this purpose, we developed and validated the Dynamic Silver Code (DSC), a score based on real-time linkage of administrative data.Design and settingThe ‘Silver Code National Project (SCNP)’, a non-concurrent cohort study, was used for retrospective development and internal validation of the DSC. External validation was obtained in the ‘Anziani in DEA (AIDEA)’ concurrent cohort study, where the DSC was generated by the software routinely used in the ED.ParticipantsThe SCNP contained 281 321 records of 180 079 residents aged 75+ years from Tuscany and Lazio, Italy, admitted via the ED to Internal Medicine or Geriatrics units. The AIDEA study enrolled 4425 subjects aged 75+ years (5217 records) accessing two EDs in the area of Florence, Italy.InterventionsNone.Outcome measuresPrimary outcome: 1-year mortality. Secondary outcomes: 7 and 30-day mortality and 1-year recurrent ED visits.ResultsAdvancing age, male gender, previous hospital admission, discharge diagnosis, time from discharge and polypharmacy predicted 1-year mortality and contributed to the DSC in the development subsample of the SCNP cohort. Based on score quartiles, participants were classified into low, medium, high and very high-risk classes. In the SCNP validation sample, mortality increased progressively from 144 to 367 per 1000 person-years, across DSC classes, with HR (95% CI) of 1.92 (1.85 to 1.99), 2.71 (2.61 to 2.81) and 5.40 (5.21 to 5.59) in class II, III and IV, respectively versus class I (p<0.001). Findings were similar in AIDEA, where the DSC predicted also recurrent ED visits in 1 year. In both databases, the DSC predicted 7 and 30-day mortality.ConclusionsThe DSC, based on administrative data available in real time, predicts prognosis of older patients and might improve their management in the ED.

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