A Brief Risk Stratification Tool to Predict Functional Decline in Older Adults Discharged from Emergency Departments

OBJECTIVES: To determine the effectiveness of the six‐item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent functional decline in older community‐dwelling adults discharged home from the emergency department (ED). DESIGN: Secondary data analysis of a rand...

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Veröffentlicht in:Journal of the American Geriatrics Society (JAGS) 2007-08, Vol.55 (8), p.1269-1274
Hauptverfasser: Hustey, Fredric M., Mion, Lorraine C., Connor, Jason T., Emerman, Charles L., Campbell, James, Palmer, Robert M.
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container_end_page 1274
container_issue 8
container_start_page 1269
container_title Journal of the American Geriatrics Society (JAGS)
container_volume 55
creator Hustey, Fredric M.
Mion, Lorraine C.
Connor, Jason T.
Emerman, Charles L.
Campbell, James
Palmer, Robert M.
description OBJECTIVES: To determine the effectiveness of the six‐item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent functional decline in older community‐dwelling adults discharged home from the emergency department (ED). DESIGN: Secondary data analysis of a randomized, controlled trial. SETTING: EDs of two urban academic hospitals. PARTICIPANTS: Six hundred fifty community‐dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as “high risk” if they had cognitive impairment or two or more risk factors on the TRST. MEASUREMENTS: Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self‐perceived physical health: standardized physical health component of the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self‐perceived physical health: follow‐up SF‐36 standardized physical health component scores four or more points lower than baseline. RESULTS: TRST scores correlated with baseline ADL impairments, IADL impairments, and self‐perceived physical health at all endpoints (P
doi_str_mv 10.1111/j.1532-5415.2007.01272.x
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DESIGN: Secondary data analysis of a randomized, controlled trial. SETTING: EDs of two urban academic hospitals. PARTICIPANTS: Six hundred fifty community‐dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as “high risk” if they had cognitive impairment or two or more risk factors on the TRST. MEASUREMENTS: Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self‐perceived physical health: standardized physical health component of the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self‐perceived physical health: follow‐up SF‐36 standardized physical health component scores four or more points lower than baseline. RESULTS: TRST scores correlated with baseline ADL impairments, IADL impairments, and self‐perceived physical health at all endpoints (P&lt;.001). A TRST score of two or more was moderately predictive of decline in ADLs or IADLs (30‐day ADL area under the receiver operating characteristic curve (AUC)=0.64; 95% confidence interval (CI)=0.56–0.72; 120‐day ADL AUC=0.66; 95% CI=0.58–0.74) but not perceived physical health. CONCLUSION: The TRST identifies baseline functional impairment in older ED patients and is moderately predictive of subsequent functional decline after an initial ED visit. The TRST provides a valid proxy measure for assessing functional status in the ED and may be useful in identifying high‐risk patients who would benefit from referrals for further evaluation or surveillance upon ED discharge.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2007.01272.x</identifier><identifier>PMID: 17661968</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Aged ; Biological and medical sciences ; emergency ; Emergency Service, Hospital ; Emergency Treatment ; Female ; functional status ; General aspects ; geriatric ; Health Status ; Humans ; Male ; Medical sciences ; Miscellaneous ; Patient Discharge ; Prevention and actions ; Public health. Hygiene ; Public health. 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DESIGN: Secondary data analysis of a randomized, controlled trial. SETTING: EDs of two urban academic hospitals. PARTICIPANTS: Six hundred fifty community‐dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as “high risk” if they had cognitive impairment or two or more risk factors on the TRST. MEASUREMENTS: Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self‐perceived physical health: standardized physical health component of the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self‐perceived physical health: follow‐up SF‐36 standardized physical health component scores four or more points lower than baseline. RESULTS: TRST scores correlated with baseline ADL impairments, IADL impairments, and self‐perceived physical health at all endpoints (P&lt;.001). A TRST score of two or more was moderately predictive of decline in ADLs or IADLs (30‐day ADL area under the receiver operating characteristic curve (AUC)=0.64; 95% confidence interval (CI)=0.56–0.72; 120‐day ADL AUC=0.66; 95% CI=0.58–0.74) but not perceived physical health. CONCLUSION: The TRST identifies baseline functional impairment in older ED patients and is moderately predictive of subsequent functional decline after an initial ED visit. The TRST provides a valid proxy measure for assessing functional status in the ED and may be useful in identifying high‐risk patients who would benefit from referrals for further evaluation or surveillance upon ED discharge.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>emergency</subject><subject>Emergency Service, Hospital</subject><subject>Emergency Treatment</subject><subject>Female</subject><subject>functional status</subject><subject>General aspects</subject><subject>geriatric</subject><subject>Health Status</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Patient Discharge</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Risk Assessment</topic><topic>screening</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hustey, Fredric M.</creatorcontrib><creatorcontrib>Mion, Lorraine C.</creatorcontrib><creatorcontrib>Connor, Jason T.</creatorcontrib><creatorcontrib>Emerman, Charles L.</creatorcontrib><creatorcontrib>Campbell, James</creatorcontrib><creatorcontrib>Palmer, Robert M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hustey, Fredric M.</au><au>Mion, Lorraine C.</au><au>Connor, Jason T.</au><au>Emerman, Charles L.</au><au>Campbell, James</au><au>Palmer, Robert M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Brief Risk Stratification Tool to Predict Functional Decline in Older Adults Discharged from Emergency Departments</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2007-08</date><risdate>2007</risdate><volume>55</volume><issue>8</issue><spage>1269</spage><epage>1274</epage><pages>1269-1274</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>OBJECTIVES: To determine the effectiveness of the six‐item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent functional decline in older community‐dwelling adults discharged home from the emergency department (ED). DESIGN: Secondary data analysis of a randomized, controlled trial. SETTING: EDs of two urban academic hospitals. PARTICIPANTS: Six hundred fifty community‐dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as “high risk” if they had cognitive impairment or two or more risk factors on the TRST. MEASUREMENTS: Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self‐perceived physical health: standardized physical health component of the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self‐perceived physical health: follow‐up SF‐36 standardized physical health component scores four or more points lower than baseline. RESULTS: TRST scores correlated with baseline ADL impairments, IADL impairments, and self‐perceived physical health at all endpoints (P&lt;.001). A TRST score of two or more was moderately predictive of decline in ADLs or IADLs (30‐day ADL area under the receiver operating characteristic curve (AUC)=0.64; 95% confidence interval (CI)=0.56–0.72; 120‐day ADL AUC=0.66; 95% CI=0.58–0.74) but not perceived physical health. CONCLUSION: The TRST identifies baseline functional impairment in older ED patients and is moderately predictive of subsequent functional decline after an initial ED visit. The TRST provides a valid proxy measure for assessing functional status in the ED and may be useful in identifying high‐risk patients who would benefit from referrals for further evaluation or surveillance upon ED discharge.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>17661968</pmid><doi>10.1111/j.1532-5415.2007.01272.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Biological and medical sciences
emergency
Emergency Service, Hospital
Emergency Treatment
Female
functional status
General aspects
geriatric
Health Status
Humans
Male
Medical sciences
Miscellaneous
Patient Discharge
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Assessment
screening
title A Brief Risk Stratification Tool to Predict Functional Decline in Older Adults Discharged from Emergency Departments
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