de Groot Aafke J, Wattel Elizabeth M, van Balen Romke, Hertogh Cees M P M, van der Wouden Johannes C
Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands.
Ann Geriatr Med Res. 2023 Dec;27(4):301-309. doi: 10.4235/agmr.23.0068. Epub 2023 Sep 11.
We assessed the vulnerability of patients aged ≥70 years during hospital admission based on the Short Dutch Safety Management Screening (DSMS). Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs.
This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups.
Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70-80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03-11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76-8.14), and positive fall risk (OR=2.87; 95% CI, 1.31-6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups.
Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care.
我们基于荷兰简短安全管理筛查（DSMS）评估了70岁及以上患者在住院期间的脆弱性。对四个老年领域进行筛查旨在预防不良后果，并可能支持针对急性后期护理的有针对性的出院计划。我们探讨了急性入院患者的DSMS标准是否与以康复为导向的护理需求相关。
这项回顾性队列研究纳入了70岁及以上急性入住三级医院的社区居住患者。我们记录了患者的人口统计学、发病率、功能状态、营养不良、跌倒风险和谵妄情况，并通过比较出院目的地组来进行描述性分析以计算风险。
在491例出院患者中，349例（71.1%）回家，60例（12.2%）被转介至老年康复机构，82例（16.7%）转至其他急性后期住院护理机构。非回家转介率随年龄增长从21%（70 - 80岁）增至61%（>90岁）。手术诊断（优势比[OR]=4.92；95%置信区间[CI]，2.03 - 11.95）、以Katz日常生活活动阳性筛查表示的功能下降（OR=3.79；95%CI，1.76 - 8.14）以及跌倒风险阳性（OR=2.87；95%CI，1.31 - 6.30）与非回家出院相关。各组间的Charlson合并症指数无显著差异。
入院诊断和脆弱性筛查结果与70岁以上患者出院接受以康复为导向的护理相关。DSMS脆弱性筛查的常规护理数据可提高对出院复杂性的认识，并提供支持及时和个性化过渡护理的机会。
