Patricia Ysabel Condorhuamán-Alvarado1, Rocío Menéndez-Colino2, Coro Mauleón-Ladrero3, Jesús Díez-Sebastián4, Teresa Alarcón5, Juan Ignacio González-Montalvo5. 1. Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España. Electronic address: patricia.condorhuaman@salud.madrid.org. 2. Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España. 3. Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España. 4. Unidad de Investigación, Hospital Universitario La Paz, Madrid, España. 5. Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España.
Abstract
OBJECTIVE: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. MATERIAL AND METHOD: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. RESULTS: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. CONCLUSIONS: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness.
OBJECTIVE: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. MATERIAL AND METHOD: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. RESULTS: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. CONCLUSIONS: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness.