Asmus-Szepesi Kirsten J E, de Vreede Paul L, Flinterman Linda E, Nieboer Anna P, Bakker Ton J E M, Borsboom Gerard J J M, Mackenbach Johan P, Steyerberg Ewout W
Erasmus University Medical Center-Public Health, Dr. Molewaterplein 50 3015 GE, Rotterdam, Netherlands.
Age Ageing. 2013 Nov;42(6):803-9. doi: 10.1093/ageing/aft126. Epub 2013 Aug 23.
hospitalised older people are at risk for poor functioning after hospital discharge. We aimed to validate the predictive ability of the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP) screening questionnaire to identify older patients at risk for functional dependence by comparing groups with different ISAR-HP scores on cognitive and physical functioning, mortality, health-related quality of life (HRQoL) and loneliness.
a longitudinal prospective cohort study.
a 450-bed hospital in the Netherlands.
four hundred and sixty patients 65 years or older admitted between June 2010 and October 2010.
participants were classified into five risk groups at hospital admission using the ISAR-HP. We interviewed patients at hospital admission and at 3 and 12 months after admission using validated questionnaires to score HRQoL, physical functioning, cognitive functioning and loneliness. Differences in survival were quantified by a concordance statistic (c).
cognitive functioning, physical functioning, loneliness and HRQoL differed significantly between groups during the 1-year follow-up after hospital admission (all comparisons P < 0.05), with high-risk groups having lower scores than low-risk groups for functioning and loneliness, although not always for HRQoL. The lowest risk group (ISAR-HP = 0) scored consistently higher on functioning and HRQoL than all other groups. Mortality differed significantly between groups (P < 0.001, c = 0.67).
the ISAR-HP can readily distinguish well-functioning older patients from patients with low functioning and low HRQoL after hospital admission. The ISAR-HP may hence assist in selecting patients who may benefit from individually tailored reactivation treatment that is provided next to treatment of their medical condition.
住院老年人出院后存在功能恢复不佳的风险。我们旨在通过比较不同ISAR-HP评分组在认知和身体功能、死亡率、健康相关生活质量（HRQoL）和孤独感方面的差异，验证风险识别-住院患者老年人（ISAR-HP）筛查问卷对识别有功能依赖风险的老年患者的预测能力。
纵向前瞻性队列研究。
荷兰一家拥有450张床位的医院。
2010年6月至2010年10月期间收治的460例65岁及以上患者。
使用ISAR-HP在入院时将参与者分为五个风险组。我们在入院时以及入院后3个月和12个月对患者进行访谈，使用经过验证的问卷对HRQoL、身体功能、认知功能和孤独感进行评分。通过一致性统计量（c）对生存率差异进行量化。
入院后1年随访期间，各风险组在认知功能、身体功能、孤独感和HRQoL方面存在显著差异（所有比较P<0.05），高风险组在功能和孤独感方面的得分低于低风险组，尽管在HRQoL方面并非总是如此。最低风险组（ISAR-HP=0）在功能和HRQoL方面的得分始终高于所有其他组。各组之间的死亡率存在显著差异（P<0.001，c=0.67）。
ISAR-HP能够轻松区分出院后功能良好的老年患者与功能差和HRQoL低的患者。因此，ISAR-HP可能有助于选择那些除了接受疾病治疗外还能从个体化的恢复治疗中获益的患者。
