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The European Journal of Public Health Advance Access published online on August 2, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki054
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received February 3, 2004
Accepted September 6, 2004

Article

Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool

Pascale Cornette 1*, Christian Swine 2, Brigitte Malhomme 3, Jean-Bernard Gillet 4, Philippe Meert 5, and William D'Hoore 6

1 Geriatric Unit, St Luc University Hospital, Université catholique de Louvain
2 Geriatric Unit, Mont-Godinne University Hospital, Université catholique de Louvain
3 Mont-Godinne University Hospital, Université catholique de Louvain
4 Emergency Unit, Mont-Godinne University Hospital, Université catholique de Louvain
5 Emergency Unit, St Luc University Hospital, Université catholique de Louvain
6 School of Public Health, Université catholique de Louvain

* To whom correspondence should be addressed.
Pascale Cornette, E-mail: cornette{at}hosp.ucl.ac.be


  Abstract

Objective: To develop a predictive tool that could be used on admission to identify older hospitalized people at risk of functional decline 3 months after discharge. Methods: This was a prospective cohort study that included 625 patients aged 70 years and older (mean age 80.0 ± 5.6 years) hospitalized by the way of the emergency room, for at least 48 h, in two academic hospitals. Three months after discharge, 550 patients remained for analysis. On admission, people were assessed for premorbid functional status with the activities of daily living (ADL) scale and instrumental ADL scale. Demographic and medical data, including cognitive function, falls, polypharmacy, comorbidity, continence, mobility and self-rated health, were collected. ADL functioning was re-assessed at discharge and 1 and 3 months later. Functional decline was defined as the loss of at least one point on the ADL scale between the premorbid and 3-month evaluation. Univariate analyses were used to select variables associated with functional decline. A logistic regression model was then constructed to predict functional status 3 months after discharge. Results: Three months after discharge, 165 (31.5%) patients had declined. The predictive tool SHERPA includes five factors: age, impairment in premorbid instrumental ADLs, falls in the year before hospitalization, cognitive impairment (Abbreviated Mini Mental State below 15/21) and poor self-rated health. Sensitivity and specificity were 67.9% and 70.8%, respectively. Conclusions: Older people are at high risk of functional decline following hospitalization. On admission, a simple instrument can easily identify these patients, even though the performance of this instrument is moderate.

Keywords: activities of daily living; elderly; functional decline; hospital; predictive tool.
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