Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.
BMC Geriatr. 2021 Apr 1;21(1):223. doi: 10.1186/s12877-021-02164-3.
Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults.
To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks.
Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA.
Fifty-two patients (median age [inter-quartile range] 86.4 [79.2-90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a 'high risk' or 'at risk' foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 'at risk' and 2 'low risk' for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7-32.1] vs 15.2 [8-22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0-3] vs 0 [0-2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001).
Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.
足部问题在老年人中很常见，与较差的身体功能、跌倒、虚弱和生活质量下降有关。综合老年评估（CGA）是一种多学科的过程，被认为是老年人护理的金标准，但在住院老年人中通常不包括足病评估和干预。
将足部评估纳入住院 CGA 中，以确定足部疾病的患病率、足部疾病危险因素和不合适的鞋类使用情况，评估足部评估的观察者间可靠性，确定当前足病的投入情况，并研究患者特征与足部疾病风险之间的关系。
对老年康复病房的老年患者进行前瞻性、观察性队列研究。除了常规 CGA 外，还使用昆士兰足部疾病表（QFDF）进行足部评估。
共纳入 52 名患者（中位年龄[四分位数范围]86.4[79.2-90.3]岁，54%为女性）。6 名患者（12%）患有足部疾病，13 名患者（25%）有“高风险”或“有风险”的足部。足部疾病危险因素的患病率为外周动脉疾病 9 例（17%）；神经病 10 例（19%）和足部畸形 11 例（22%）。41 名患者（85%）穿着不合适的鞋子。足部疾病和动脉疾病的观察者间一致性为中等，足部畸形和神经病以及不合适的鞋子的观察者间一致性为差到中等。8 名患者（15%）在住院期间看了足病医生：5 名有足部疾病，1 名有“风险”，2 名有“低风险”足部疾病。有风险的足部或足部疾病的患者的中位住院时间明显更长（25[13.7-32.1]与 15.2[8-22.1]天，p=0.01），营养不良筛查测试评分中位数也更高（2[0-3]与 0[0-2]，p=0.03）比低危组。患有足部疾病的患者最有可能看足病医生（p<0.001）。
足部疾病、足部疾病危险因素和不合适的鞋子在住院老年人中很常见，但足病评估和干预主要限于足部疾病患者。应考虑在多学科 CGA 团队中常规进行足部评估。检查动脉疾病和营养不良风险可能有助于识别需要接受足病检查的高危患者。
