Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment

Scharf, Anne-Carina; Gronewold, Janine; Dahlmann, Christian; Schlitzer, Jeanina; Kribben, Andreas; Gerken, Guido; Rassaf, Tienush; Kleinschnitz, Christoph; Dodel, Richard; Frohnhofen, Helmut

doi:10.1186/s12877-019-1239-3

Cited by 14 publications

(13 citation statements)

References 42 publications

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“…For this reason, different methods have been suggested in the literature to admit older patients to emergency services. [21][22][23][24][25] In recent times, hospitals have begun to restructure their physical environments for older patients, and some have set up geriatric monitoring departments with bed capacities of four to seven. [20]…”

Section: Discussionmentioning

confidence: 99%

Analysis of Hospitalized Geriatric Patients from an Emergency Department

Yildirim

Kaya

Genc³

et al. 2021

Journal of Contemporary Medicine

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The increase in the geriatric population in industrialized countries also increases the rate at which this group utilizes emergency services. Evaluation of this patient group is not specific to a single discipline, but requires a multidisciplinary approach. Information obtained by examining emergency service use among geriatric patients can inform us of approaches to improve hospital efficiency and potentially reduce the morbidity and mortality rates. Material and Method:This study investigated the retrospective records of geriatric patients who presented to emergency services during 2016 Kütahya Evliya Çelebi Training and Research Hospital, Turkey. Demographic characteristics, diagnoses, hospitalization rates, hospitalization according to clinics, seasonal characteristics, duration of hospital, and patient outcomes were evaluated. Study data were evaluated using the SPSS 20.00 statistical program.Results: A total of 314.178 patients opted for emergency services during 2016, and 29.163 (9.2%) were 65 years old and older. Among these patients, 10.545 were hospitalized, of whom 4.246 (40.2%) were aged 65 years or older. The most frequently utilized hospital units were the cardiology (n=723, 17.02%), the neurology (n=717, 16.88%), and the chest diseases (n=674, 15.87%). Conclusion:The geriatric population requires that necessary changes should be made in healthcare structures. Our study, which evaluates hospitalization rates and health status in geriatric population at a provincial which can also provide a regional level, can help in making patient admission, follow-up, and rehabilitation more comprehensive.

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Section: Discussionmentioning

confidence: 99%

Analysis of Hospitalized Geriatric Patients from an Emergency Department

Yildirim

Kaya

Genc³

et al. 2021

Journal of Contemporary Medicine

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“…The available data were obtained prospectively. More detailed information about study cohort characteristics and methodology have previously been reported (see [13]). The study was approved by the ethics committee of the University Duisburg-Essen and need for consent was waived.…”

Section: Study Cohortmentioning

confidence: 99%

“…For high-risk patients with positive ISAR screening a comprehensive geriatric assessment (CGA) is recommended as a second diagnostic step. The ISAR screening in combination with the CGA has recently been validated for acute medical departments by Scharf et al [13]. Since the CGA is a timeand resource consuming assessment it is not efficient to perform CGA in all patients [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…To further improve the process by which greater medical care is granted to certain patients, we need to understand which patient characteristics are associated with patient's needs for intensified medical care in hospital environments. In our last manuscript, we evaluated the diagnostic validity of the ISAR score and the CGA conducting cutoff-and sensitivity/specificity analyses [13]. We now focus on the clinical application of these tools and study how patient characteristics, the ISAR score and CGA results are associated with length of hospital stay, nursing hours, and receiving physiotherapy in older internal medicine patients.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Scharf,

Gronewold,

Dahlmann

et al. 2020

BMC Geriatr

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Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: Two hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β = − 0.19, 95% confidence interval (CI) = − 0.66;-0.13), number of admission diagnoses (β = 0.28, 95% CI = 0.16;0.41), ADL impairment (B = 6.66, 95% CI = 3.312;10.01), and signs of depression (B = 6.69, 95% CI = 1.43;11.94) independently predicted length of hospital stay. ADL impairment (B = 1.14, 95%CI = 0.67;1.61), cognition impairment (B = 0.57, 95% CI = 0.07;1.07) and ISAR score (β =0.26, 95% CI = 0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR) = 1.06, 95% CI = 1.04;1.08), ADL impairment (RR = 3.54, 95% CI = 2.29;5.47), cognition impairment (RR = 1.77, 95% CI = 1.20;2.62) and signs of depression (RR = 1.99, 95% CI = 1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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“…For high-risk patients with positive ISAR screening a comprehensive geriatric assessment (CGA) is recommended as a second diagnostic step. The ISAR screening in combination with the CGA has recently been validated for acute medical departments by Scharf et al [13]. Since the CGA is a time-and resource consuming assessment it is not efficient to perform CGA in all patients [14,15].…”

Section: Introductionmentioning

confidence: 99%

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Scharf

Gronewold

Dahlmann

et al. 2020

Preprint

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Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), and signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61), cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment

Cited by 14 publications

References 42 publications

Analysis of Hospitalized Geriatric Patients from an Emergency Department

Analysis of Hospitalized Geriatric Patients from an Emergency Department

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

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