Identifying vulnerable older adults at risk for functional decline in cardiac care wards: time to shift the paradigm.

IF 1.6 4区 医学 Q2 Medicine Acta Clinica Belgica Pub Date : 2023-02-01 DOI:10.1080/17843286.2022.2031374
Anthony Jeuris, Bastiaan Van Grootven, Lisa Geyskens, Koen Milisen, Johan Flamaing, Mieke Deschodt
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Abstract

Objective: To determine whether routine screening with the Flemish version of the Triage Risk Screening Tool (fTRST) is a valid approach to determine which patients on cardiac care wards are at risk for inhospital functional decline and would benefit from geriatric expertise consultation.

Methods: A secondary data-analysis of the G-COACH before-cohort, describing patient profiles and routine care processes, in 189 older adults on two cardiac care wards in the University Hospitals Leuven between September 2016 and June 2017. Inhospital functional decline was defined as an increase of at least one point on the Katz Index of Activities of Daily Living or death between hospital admission and discharge.

Results: Nine in 10 patients had at least one geriatric syndrome and one-third developed functional decline. Based on the fTRST proposed cut-off of ≥2, 156 (82.5%) patients were at risk for functional decline (sensitivity of 95.2%, specificity of 23.8%, negative predictive value of 90.9% and Area Under the Curve of 0.60). Of the 156 'at risk' patients, 43 (27.6%) received a consultation by the geriatric consultation team after a median of four hospitalization days. A positive fTRST was not significantly related to geriatric consultations (x2 = 0.57; p = 0.45).

Conclusion: The fTRST has a low discriminative value in identifying older cardiology patients at risk for functional decline. Given the high prevalence of geriatric syndromes, we propose a new paradigm were all older adults on cardiac care wards undergo a needs assessment upon hospital admission.

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识别易受伤害的老年人在心脏护理病房功能下降的风险:时间转变范式。
目的:确定佛兰德版本的分诊风险筛查工具(fTRST)的常规筛查是否是一种有效的方法,以确定哪些患者在心脏护理病房有住院功能衰退的风险,并从老年专家咨询中获益。方法:对2016年9月至2017年6月期间在鲁汶大学医院两个心脏护理病房的189名老年人的G-COACH前队列进行二次数据分析,描述患者概况和常规护理过程。住院功能下降定义为入院和出院之间的Katz日常生活活动指数或死亡增加至少1点。结果:10名患者中有9名至少有一种老年综合征,三分之一的患者出现功能衰退。根据fTRST建议的临界值≥2,156例(82.5%)患者存在功能衰退风险(敏感性95.2%,特异性23.8%,阴性预测值90.9%,曲线下面积0.60)。在156名“高危”患者中,43名(27.6%)在平均住院4天后接受了老年咨询小组的咨询。fTRST阳性与老年会诊无显著相关(x2 = 0.57;P = 0.45)。结论:fTRST在识别有功能衰退风险的老年心脏病患者方面具有较低的鉴别价值。鉴于老年综合征的高患病率,我们提出了一种新的范式,即所有在心脏护理病房的老年人在入院时接受需求评估。
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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