Predictive value of nonspecific symptoms for acute illness in nursing home residents.
OBJECTIVE
To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents.


METHODS
Prospective, observational study.


METHODS
Academic nursing home located in an urban setting.


METHODS
Two hundred two newly admitted residents.


METHODS
Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae.


RESULTS
Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91.


CONCLUSIONS
Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness.
Boockvar
Kenneth S
KS
Brookdale Department of Geriatrics and Adult Development, Mount Sinai School Of Medicine, New York, New York, USA. kenneth.boockvar@mssm.edu
Lachs
Mark S
MS
D000208:Acute Disease; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors