Kenneth S Boockvar1, Mark S Lachs. 1. Brookdale Department of Geriatrics and Adult Development, Mount Sinai School Of Medicine, New York, New York, USA. kenneth.boockvar@mssm.edu
Abstract
OBJECTIVES: To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents. DESIGN: Prospective, observational study. SETTING: Academic nursing home located in an urban setting. PARTICIPANTS: Two hundred two newly admitted residents. MEASUREMENTS: Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae. RESULTS: Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91. CONCLUSION: Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness.
OBJECTIVES: To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents. DESIGN: Prospective, observational study. SETTING: Academic nursing home located in an urban setting. PARTICIPANTS: Two hundred two newly admitted residents. MEASUREMENTS: Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae. RESULTS: Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91. CONCLUSION: Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness.
Authors: Marilyn Rantz; Lorraine J Phillips; Colleen Galambos; Kari Lane; Gregory L Alexander; Laurel Despins; Richelle J Koopman; Marjorie Skubic; Lanis Hicks; Steven Miller; Andy Craver; Bradford H Harris; Chelsea B Deroche Journal: J Am Med Dir Assoc Date: 2017-07-12 Impact factor: 4.669
Authors: Philip D Sloane; Christopher H Schifeling; Anna S Beeber; Kimberly T Ward; David Reed; Lisa P Gwyther; Bobbi Matchar; Sheryl Zimmerman Journal: J Am Geriatr Soc Date: 2017-02-02 Impact factor: 5.562
Authors: Gregory L Alexander; Marilyn Rantz; Marjorie Skubic; Richelle J Koopman; Lorraine J Phillips; Rainer D Guevara; Steven J Miller Journal: J Healthc Eng Date: 2011 Impact factor: 2.682
Authors: Gregory L Alexander; Marilyn Rantz; Marjorie Skubic; Myra A Aud; Bonnie Wakefield; Elena Florea; Anindita Paul Journal: Res Gerontol Nurs Date: 2008-10 Impact factor: 1.571
Authors: Julie M Ellis; Jeanne A Teresi; Mildred Ramirez; Stephanie Silver; Gabriel Boratgis; Jian Kong; Joseph P Eimicke; Gail Sukha; Mark S Lachs; Karl A Pillemer Journal: J Contin Educ Nurs Date: 2014-02-23 Impact factor: 1.224