Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Collective Health, San Mateo, California, USA.
J Am Geriatr Soc. 2023 Oct;71(10):3221-3228. doi: 10.1111/jgs.18456. Epub 2023 Jun 2.
Mobility loss is common in hospitalized older adults, and resources to prevent mobility impairment are finite. Our goal was to use routinely collected data to develop a risk assessment tool that identifies individuals at risk of losing the ability to walk during hospitalization on the first hospital day. Second, we determined if the tool could inform the use of mobility-preserving interventions.
We included patients admitted to a general medical service, aged ≥65 years, who walked occasionally or frequently on admission (Braden Scale Activity subset > = 3). Patients were considered to have a new mobility impairment if, at discharge, their ability to walk was severely limited or nonexistent or they were confined to bed (Braden Scale Activity subset <3). We used predictors available on the first hospital day to develop (2017-18 cohort) and validate (2019 cohort) a risk assessment tool. We determined the association between predicted risk and therapy use in the validation cohort to highlight the model's clinical utility.
5542 patients were included (median age 76 years, 48% women); 7.6% were discharged unable to walk. The model included 5 predictors: age, medication administrations, Glasgow Coma Scale verbal score, serum albumin, and urinary catheter presence. In the validation cohort, the model discriminated well (c-statistic 0.75) and was strongly associated with hospital-acquired mobility impairment (lowest decile 1%, highest decile 25%). In the validation cohort, therapy consultation ordering increased linearly with predicted risk; however, observed mobility impairment increased exponentially.
The tool assesses the risk of mobility impairment in all ambulatory hospitalized older adults on the first hospital day. Further, it identifies at-risk older adults who may benefit from mobility interventions.
在住院的老年人中，行动能力丧失很常见，而预防行动能力受损的资源是有限的。我们的目标是利用常规收集的数据开发一种风险评估工具，该工具可在入院的第一天识别出有丧失行走能力风险的个体。其次，我们确定该工具是否可以为保留活动能力的干预措施提供信息。
我们纳入了在综合医疗服务中入院、年龄≥65 岁、入院时偶尔或经常行走（Braden 量表活动子量表> = 3）的患者。如果患者出院时行走能力严重受限或不存在，或被限制卧床（Braden 量表活动子量表<3），则认为他们出现了新的活动能力受损。我们使用入院第一天可获得的预测因素来开发（2017-18 队列）和验证（2019 队列）风险评估工具。我们在验证队列中确定预测风险与治疗使用之间的关联，以突出模型的临床实用性。
共纳入 5542 例患者（中位年龄 76 岁，48%为女性）；7.6%的患者出院时无法行走。该模型包括 5 个预测因素：年龄、药物治疗、格拉斯哥昏迷量表言语评分、血清白蛋白和导尿管的存在。在验证队列中，该模型具有良好的区分度（C 统计量为 0.75），与医院获得性活动能力受损密切相关（最低十分位数为 1%，最高十分位数为 25%）。在验证队列中，治疗咨询的开单量与预测风险呈线性增加；然而，观察到的活动能力受损呈指数增加。
该工具可在入院的第一天评估所有活动能力的住院老年患者的活动能力受损风险。此外，它还可以识别出有活动能力受损风险的老年人，这些老年人可能受益于活动能力干预措施。
