Screening tools to identify hospitalised elderly patients at risk of functional decline: a systematic review

Sutton, Matthew; Grimmer, Karen; Jeffries, Leah J.

doi:10.1111/j.1742-1241.2008.01930.x

Cited by 66 publications

(81 citation statements)

References 29 publications

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“…14 Key informant interviews (pre-surveying) were conducted to establish survey feasibility, obtain current knowledge on functional decline, and determine ideal methods of gathering information on sensitivity and minimal point drop on the OARS ADL Scale. Cognitive interviews were conducted to evaluate the clarity, comprehensibility, and face validity of the draft survey instrument.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…3,5 Approximately 10%-45% of the patients will develop a decline in function that persists up to seven months post injury. [3][4][5][6][7][8][9][10][11][12][13] Functional decline, or the reduction in ability to perform self-care activities of daily living (ADL) because of a decrement in physical functioning, [14][15][16][17] is a common and serious problem in elderly patients. 16,17 Functional decline is associated with social isolation, reduced quality of life, and death.…”

Section: Introductionmentioning

confidence: 99%

“…16,17 Functional decline is associated with social isolation, reduced quality of life, and death. 3,5,7,8,14,[18][19][20][21][22] It is also an important predictor of hospitalization, 23,24 prolonged hospital stay, 25 repeat ED visits, 7,26 and the need for home care 25 . Moreover, functional decline is the most important predictor of admission to institutions and of disproportionate use of health services by the elderly population.…”

Section: Introductionmentioning

confidence: 99%

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National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Abdulaziz

Brehaut

Taljaard

et al. 2015

CJEM

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Background: There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. Methods: After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. Results: Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. Conclusions: A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

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Section: Study Design and Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Abdulaziz

Brehaut

Taljaard

et al. 2015

CJEM

View full text Add to dashboard Cite

show abstract

“…25 To aid the development of the final survey questionnaire, the survey was developed in three stages: 1) key informant, in-person interviews (pre-survey), 2) cognitive interviews (draft survey), and 3) pilot-testing (final draft survey). The key informant and cognitive interviews were conducted on convenience samples of neurologists and emergency physicians.…”

Section: Questionnaire Developmentmentioning

confidence: 99%

National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk

Perry

Losier

Stiell

et al. 2015

CJEM

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Introduction: Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke. Methods: After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. Results: From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimalrisk: <1%; low-risk: 1%-4.9%; high-risk 5%-10%; critical-risk: > 10% risk of subsequent stroke within 7 days. Conclusion: A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.

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“…Frailty is characterized by a decrease in functional decline and the development of disability. Functional decline is defined as "The decrease in ability to perform the tasks of everyday living because of a decrement in physical, psychological and/or cognitive functioning" [10]. Functional decline is usually episodic and is associated with a high risk of general health decline.…”

Section: Introductionmentioning

confidence: 99%

The most important considerations in the assessment of functional decline in seniors: a literature review

Jahan¹

2017

APJHS

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In recent years, there has been much focus on functional decline associated with aging, but not many studies have examined how functional decline can be effectively evaluated and detected at earlier stages of the aging process. Early detection of functional decline helps to intervene much earlier to avoid many of negative consequences of functional decline and frailty. Late identification of functional decline is problematic to the individuals and the healthcare systems considering that the percentage of the world population represented by people over the age of 65 is increasing rapidly worldwide. The aim of this review was to investigate the most important considerations in the assessment of functional decline in the population of seniors, and to explore relevant literature to provide a ground for an effective functional assessment for this population. Comprehensive literature search of the English-language articles for people aged 65 and over were conducted by searching MEDLINE and PubMed. The literature describes two main segments of elderly population with functional decline that should be assessed in different ways: Hospitalized and community-dwelling elders. When working with elderly clients, it is significantly important to identify all the factors that may contribute to the clinical picture of the client. Identification of risk factors, such as inability to do basic activities of daily living, social isolation, or lack of resources may help healthcare providers to intervene on time to avoid many catastrophic changes that affect seniors' health-related quality of life.

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Screening tools to identify hospitalised elderly patients at risk of functional decline: a systematic review

Cited by 66 publications

References 29 publications

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk

The most important considerations in the assessment of functional decline in seniors: a literature review

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