Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Age Ageing. 2012 May;41(3):381-7. doi: 10.1093/ageing/afs015. Epub 2012 Feb 28.
thirty to sixty per cent of older patients experience functional decline after hospitalisation, associated with an increase in dependence, readmission, nursing home placement and mortality. First step in prevention is the identification of patients at risk.
to develop and validate a prediction model to assess the risk of functional decline in older hospitalised patients.
development study: cohort study (n = 492). Validation study: secondary data analysis of a cohort study (n = 484) in an independent population. Both with follow-up after 3 months. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow-up compared with pre-admission status.
development study: general internal medicine wards of two university hospitals and one regional hospital. Validation study: general internal wards of an university hospital.
patients ≥65 years acutely admitted and hospitalised for at least 48 h.
thirty-five per cent of all patients in the development cohort and 32% in the validation cohort developed functional decline. A four-item model could accurately predict functional decline with an AUC of 0.71. At threshold 2 sensitivity, specificity, positive and negative predictive values were 87, 39, 43 and 85%, respectively. In the validation study, this was, respectively, 0.68, 89, 41, 41 and 89%.
pre-admission need for assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14, are the items of a prediction model to identify older patients at risk for functional decline following hospital admission. The strength of the model is that it relies on four simple questions and this makes it easy to use in clinical practice and easy to administer.
30%至 60%的老年住院患者在出院后会出现功能下降，这与依赖程度增加、再入院、入住养老院和死亡率增加有关。预防的第一步是识别有风险的患者。
制定并验证一种预测模型，以评估老年住院患者发生功能下降的风险。
开发研究：队列研究（n=492）。验证研究：对另一项队列研究（n=484）的二次数据分析，在独立人群中进行。随访时间均为 3 个月。功能下降定义为与入院前相比，在随访时 Katz ADL 指数至少下降 1 分。
开发研究：两家大学医院和一家地区医院的普通内科病房。验证研究：一家大学医院的普通内科病房。
年龄≥65 岁，急性入院，住院时间至少 48 小时。
开发队列中有 35%的患者，验证队列中有 32%的患者发生了功能下降。一个包含四项指标的模型可以准确预测功能下降，AUC 为 0.71。在阈值为 2 时，敏感性、特异性、阳性预测值和阴性预测值分别为 87%、39%、43%和 85%，在验证研究中，这四个值分别为 0.68、89%、41%、41%和 89%。
入院前需要辅助日常生活活动、使用助行器、需要协助行走和 14 岁后没有受过教育，这些是识别老年患者在住院后发生功能下降风险的预测模型的项目。该模型的优势在于它仅依赖于四个简单的问题，这使其易于在临床实践中使用和管理。
