Abstract
BackgroundHospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay.MethodsFive hundred forty-seven internal medicine in-patients (mean age 78.14 ± 5.96 years; 54.7% males) prospectively received Identification of Seniors at Risk (ISAR) screening. If screening results were positive (ISAR score ≥ 2), a comprehensive geriatric assessment (CGA) was performed. We explored sensitivity and specificity of different ISAR and CGA cutoffs. Further, we analyzed the risk of falls and how patients got discharged from hospital.ResultsISAR+/CGA abnormal patients spent more days in hospital (16.1 ± 14.5), received more nursing hours per day (3.0 ± 2.3), more hours of physiotherapy during their hospital stay (2.2 ± 3.2), and had more falls (10.1%) compared to ISAR+/CGA normal (10.9 ± 12.3, 2.0 ± 1.2, 1.2 ± 4.3, and 2.8%, respectively, all p ≤ 0.016) and ISAR- (9.6 ± 11.5, 2.3 ± 4.5, 0.7 ± 2.0, and 2.2%, respectively, all p ≤ 0.002) patients. ISAR+/CGA abnormal patients terminated their treatment regularly with being discharged back home less often (59.6%) compared to ISAR+/CGA normal (78.5%, p = 0.002) and ISAR- (78.2%, p = 0.056) patients. ISAR cutoff≥2 and CGA defined as abnormal in case of impairment of ADL plus another CGA domain achieved best sensitivity/specificity.ConclusionsAbnormal geriatric risk screening and assessment are associated with longer hospital stay and higher amount of nursing and physiotherapy during hospital stay, greater risk of falling, and a lower percentage of successfully terminated treatment in older in-patients.
Highlights
Hospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay
We explored the sensitivity and specificity of different Identification of Seniors at Risk (ISAR) and comprehensive geriatric assessment (CGA) cutoffs for identifying outcomes among older adults admitted to internal medicine departments
CGA Since there is an ongoing discussion on which geriatric impairments are associated with deteriorated health condition, we analyzed different definitions of an abnormal CGA, which included the Barthel index for the assessment of impairment of activities of daily living (ADL) [15, 16], the Timed Up & Go [17] and the Tinetti Mobility Test [18] measuring impairment of mobility, the Mini-Mental State Examination Test (MMSE) [19] and the Clock-Drawing Test [20] assessing impairment of cognition, and the Geriatric Depression Scale (GDS) [21, 22] for the assessment of signs of depression
Summary
Hospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay. Despite being only a diagnostic tool and not an intervention strategy, CGA preceded by ISAR screening has already been shown to reduce the risk for poor health outcomes in older patients attending emergency departments [8]. It further improves postoperative outcomes (mortality, delirium, and length of hospital stay) in older patients with colorectal carcinoma undergoing elective resection [9]. These data suggest that CGA leads to an improvement of individual patient health outcomes while lowering the costs associated with diseases, nursing, and health care [10]
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