A PREDICTIVE INDEX FOR FUNCTIONAL DECLINE IN HOSPITALIZED ELDERLY MEDICAL PATIENTS

被引:194
作者
INOUYE, SK
WAGNER, DR
ACAMPORA, D
HORWITZ, RI
COONEY, LM
HURST, LD
TINETTI, ME
机构
[1] the Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
[2] the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
关键词
ACTIVITIES OF DAILY LIVING; GERIATRICS; HOSPITAL OUTCOMES; PROSPECTIVE COHORT STUDY; PREDICTIVE MODEL; ELDERLY; FUNCTIONAL DECLINE;
D O I
10.1007/BF02598279
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective. To prospectively develop and validate a predictive index to identify on admission elderly hospitalized medical patients at risk for functional decline. Design: Two prospective cohort studies, in tandem. The predictive model developed in the initial cohort was subsequently validated in a separate cohort. Setting: General medical wards of a university teaching hospital. Patients: For the development cohort, 188 hospitalized general medical patients aged greater-than-or-equal-to 70 years. For the validation cohort, 142 comparable patients. Measurement and main results: The subjects and their nurses were interviewed twice weekly using standardized, validated instruments. Functional decline occurred among 51/188 (27%) patients in the development cohort. Four independent baseline risk factors (RFs) for functional decline were identified: decubitus ulcer (adjusted relative risk [RR] 2.7; 95% confidence interval [CI] 1.4, 5.2); cognitive impairment (RR 1.7; CI 0.9, 3.1); functional impairment (RR 1.8; CI 1.0, 3.3); and low social activity level (RR 2.4; CI 1. 2, 5. 1). A risk-stratification system was developed by adding the numbers of RFs. Rates of functional decline for the low- (0 RF), intermediate- (1 - 2 RFs), and high- (3-4 RFs) risk groups were 8%, 28%, and 63%, respectively (p < 0.000 1). The corresponding rates in the validation cohort, of whom 34/142 (24%) developed functional decline, were 6%, 29%, and 83% (p < 0.000 1). The rates of death or nursing home placement, clinical outcomes associated with functional decline in the hospital, were 6%, 19%, and 41% (p < 0.002) in the development cohort and 10%, 32%, and 67% (p < 0.001) in the validation cohort, respectively, for the three risk groups. Conclusions: Functional decline among hospitalized elderly patients is common, and a simple predictive model based on four risk factors can be used on admission to identify elderly persons at greatest risk.
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页码:645 / 652
页数:8
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