Department of Nursing, Kuang Tien General Hospital, Taichung 437021, Taiwan.
School of Nursing, China Medical University, Taichung 406040, Taiwan.
Int J Environ Res Public Health. 2022 May 30;19(11):6685. doi: 10.3390/ijerph19116685.
Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d' Evaluation du Risque de Perte d'Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward.
A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission.
Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively.
All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.
功能下降和对他人的依赖增加是住院老年患者常见的健康问题。然而，目前仍然缺乏一种经过充分验证的工具来预测老年患者的功能下降。因此，本研究旨在评估和比较 Identification of Seniors at Risk-Hospitalized Patients（ISAR-HP）、Variable Indicative of Placement Risk（VIP）和 Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie（SHERPA）这三种工具在预测住院老年患者出院后 30 天内功能下降方面的诊断准确性。
在台湾中部一所教学医院的内科病房，对 197 名老年住院患者进行了前瞻性、纵向研究。数据收集分为两次，第一次是在住院后 48 小时内，第二次是通过电话在出院后 30 天进行。收集的变量包括人口统计学数据、日常生活活动能力（ADL）的巴氏量表以及筛查工具。巴氏量表用于测量功能障碍。功能下降定义为与入院前相比，出院后 30 天内巴氏量表评分至少下降 5 分。
患者的平均年龄为 77.7 岁，其中 55.7%为女性。所有患者中有 39.1%出现功能下降。ISAR-HP 的最佳截断值、灵敏度、特异度和受试者工作特征曲线下面积分别为 2.5、96.1%、52.5%和 0.751；VIP 的最佳截断值、灵敏度、特异度和受试者工作特征曲线下面积分别为 1.5、83.1%、62.5%和 0.761；SHERPA 的最佳截断值、灵敏度、特异度和受试者工作特征曲线下面积分别为 4.75、89.6%、54.2%和 0.758。
所有三种工具的最佳截断值均表明其具有中等诊断准确性。因此，本研究结果可为临床环境中预测住院老年患者功能下降选择合适的评估工具提供指导。
