Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults

Liu, Stephen K.; Montgomery, J. Willard; Yan, Yu; Mecchella, John N.; Bartels, Stephen J.; Masutani, Rebecca; Batsis, John A.

doi:10.1111/jgs.14345

Cited by 22 publications

(28 citation statements)

References 28 publications

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“…Promoting mobility including ambulation, sitting in the chair and range-of motion are critical, basic nursing care activities that nurses should be doing routinely (Doenges, Moorhouse, & Murr, 2014). Muscle atrophy and muscle weakness are consequences of immobility (Cruz-Jentoft et al, 2010), leading to hospital readmissions (Fisher, Graham, Krishnan, & Ottenbacher, 2016), hospitalacquired comorbid conditions (Peterson & Braunschweig, 2016), and preventable nursing home admission (Liu et al, 2016). Complications resulting from insufficient mobility while hospitalized Barriers to Promoting Mobility can place increased burdens on family members and require increased healthcare system resources (D'Ambruoso & Cadogan, 2012).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Promoting Mobility in Hospitalized Older Adults

Dermody¹,

Kovach²

2018

Research in Gerontological Nursing

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Hospitalized older adults who do not receive sufficient mobility are more likely to sustain negative health outcomes, including higher rates of mortality and institutionalization. Accordingly, the purpose of the current secondary data analysis was to examine the nurse-promoted mobility of hospitalized older adults and the association between nurses' barriers and nurse-promoted mobility. In addition, the relationship among patient severity of illness, proxy levels for function, and nurse-promoted mobility was examined. The final study sample included 61 nurses working in medical units caring for a total of 77 older adults. Findings suggest nurse knowledge gaps and attitude barriers could potentially influence the type and frequency of mobility they promote in older patients. A relationship was found between older patients with impaired mobility using assistive devices for mobility at home, and those at high risk for falls and nurses promoting more sedentary activity (e.g., chair sitting, walking in the room). Interestingly, nurses promoted significantly more sedentary mobility for patients with physical therapy orders. [Res Gerontol Nurs. 2018; 11(1):17-27.].

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Section: Introductionmentioning

confidence: 99%

Barriers to Promoting Mobility in Hospitalized Older Adults

Dermody¹,

Kovach²

2018

Research in Gerontological Nursing

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“…8 Despite work demonstrating that people discharged to SNFs are more likely to be older, be insured through Medicare, have had a longer inpatient length of stay, and have poorer functional status, 9,10 it is not clear the degree to which home support influences SNF use after hospitalization. 11 Evidence suggests that limited home support is associated with poor health status, 12,13 which in turn could increase SNF use after discharge for rehabilitation needs. Alternatively, individuals who have limited home support might be discharged to SNFs at high rates for nonrehabilitation needs because they do not have the support needed to convalesce at home.…”

mentioning

confidence: 99%

Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults

Lage

Jernigan

Chang

et al. 2017

J American Geriatrics Society

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Background/Objectives Community‐based older adults are increasingly living alone. When they become ill, they might need greater support from the healthcare system than would those who live with others. There also has been a growing concern about the high use of postacute care such as skilled nursing facility (SNF) care and the level of variation in this use between hospitals and regions. Our objective was to examine whether living alone contributed to the risk of being discharged to a SNF. Design Retrospective cohort study. Setting Massachusetts General Hospital. Participants Community‐dwelling individuals aged 50 and older admitted to the medical service and discharged alive between July 2014 and August 2015 (N = 7,029). Measurements We extracted demographic, clinical, and functional data from the electronic medical record and used multivariable logistic regression to determine whether living alone at the time of hospitalization was associated with subsequent discharge to a SNF. Results Of eligible individuals, 24.8% reported living alone before admission. Those living alone were more likely to be female, older, and more independent before admission than those living with others. Of all participants, 10.9% were discharged to a SNF. After adjustment, participants living alone had more than twice the odds of being discharged to a SNF (odds ratio = 2.23, 95% confidence interval = 1.85–2.69, P < .001). Discussion People living alone are more likely to be discharged to SNFs, even when compared to other individuals with similar levels of clinical complexity and functional status. To the extent that this variation is due to a lack of home support, it could be possible to reduce SNF use through additional home services after hospital discharge.

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“…Los resultados de la escala HARP revelaron que el 50% de pacientes mayores tenían riesgo medio y alto de deterioro funcional, o dicho de otra forma, uno de cada dos pacientes mayores tenía este riesgo, principalmente en el grupo de edad de 85 y más años (93,5%). Esta situación refleja de forma indirecta el incremento en los índices de fragilidad del paciente mayor (15), pero al igual que describen otros autores, no es la herramienta para predecir de buena forma la evolución del deterioro funcional según condición de salud física o mental a tal punto, que es catalogado como pobre predictor de calidad de vida por algunos autores (24). Aunque en el proceso metodológico para el desarrollo y validación de la escala HARP se utilizó una cohorte prospectiva en un estudio multicéntrico realizado en dos hospitales privados y cuatro hospitales universitarios, incluyendo una cohorte de desarrollo (n= 448) y otra de validación (n= 379), el análisis de regresión logística reveló tres factores predictivos independientes para deterioro funcional: edad avanzada, deterioro cognitivo y un score de actividades instrumentales de la vida diaria.…”

Section: Discussionunclassified

“…A mayor puntuación global en el HARP se estima que mayor será la fragilidad o el riesgo de declive funcional. El instrumento fue desarrollado y validado en 1996 por Sager et al, (13) con el propósito de crear una herramienta que permita identificar e intervenir pacientes mayores con riesgo de pérdida de funcionalidad después de la hospitalización (15)(16)(17).…”

Section: Instrumentosunclassified

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Análisis del riesgo de deterioro funcional y sociofamiliar en el adulto mayor hospitalizado

Torres

Rivera

Mendivelso

et al. 2019

Rev. Médica Sanitas

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Introducción: El adulto mayor es una persona vulnerable clínicamente, biológica, emocional y socialmente. El objetivo de este trabajo es identificar la prevalencia de riesgo de deterioro funcional, pérdida de autonomía y vulnerabilidad sociofamiliar en personas mayores hospitalizadas en una institución de salud. Metodología: Diseño de corte transversal con pacientes >65 años hospitalizados en institución de alta complejidad. Se excluyeron hospitalizados en unidad de cuidados intensivos, patología quirúrgica, oncológica y psiquiátrica. Los instrumentos de medición fueron aplicados mediante entrevista por trabajadoras sociales de la institución previo entrenamiento y estandarización en la técnica de entrevista. Se utilizó la escala de riesgo de deterioro funcional (HARP) y la versión abreviada y simplificada de la escala de valoración sociofamiliar de GIJÓN. Resultados: Evaluamos consecutivamente 981 pacientes durante un periodo de nueve meses en el servicio de hospitalización de adultos. Edad promedio del grupo 78 años, mayor prevalencia de mujeres (63%), alta frecuencia de casados (71%) y trabajadores jubilados o pensionados (82%). El 7,5% de los pacientes egresaron al programa de hospitalización domiciliaria. La prevalencia de riesgo deterioro funcional (HARP) fue del 50% con mayor compromiso en grupo de 85+ años (74%). La valoración de GIJÓN identificó limitación de recursos sociofamiliares en 4%. Discusión: La escala HARP y GIJÓN son instrumentos de fácil aplicación y complementan la valoración clínica del adulto mayor hospitalizado. Para los departamentos de atención al usuario y de asistencia social hospitalaria constituyen Revista Médica Sanitas 7 ANÁLISIS DEL RIESGO DE DETERIORO FUNCIONAL Y SOCIOFAMILIAR EN EL ADULTO MAYOR HOSPITALIZADO un estándar de calidad, dado que permiten conocer otras dimensiones como el entorno social, familiar, neuropsicológico y en algunos casos medio-ambientales en procura del cuidado integral.

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Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults

Cited by 22 publications

References 28 publications

Barriers to Promoting Mobility in Hospitalized Older Adults

Barriers to Promoting Mobility in Hospitalized Older Adults

Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults

Análisis del riesgo de deterioro funcional y sociofamiliar en el adulto mayor hospitalizado

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