Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools.
BACKGROUND
Functional decline frequently occurs following hospitalisation in older people and may be prevented or minimized by specific management. Such care processes needs appropriate early screening of older hospitalized patients.


OBJECTIVE
To identify instruments able to detect on admission older hospitalized patients at risk of functional decline at and after discharge.


METHODS
Functional decline is defined as loss of independence in activities of daily living (functional decline) or admission in nursing home. The systematic search used Medline 1970-2007, Web of Science 1981-2007 and references list of relevant papers. An independent epidemiologist assessed methodological quality of the retained articles.


RESULTS
We found 12 studies developing predictive tools, including 7145 patients. Functional outcomes were assessed at or after discharge. Preadmission functional status, cognition, and social support were major components for prediction of functional evolution. Few instruments are fully validated and data concerning reliability are often lacking. Operational characteristics are moderate (sensitivity 29-87%, negative likelihood ratio 0.2-0.8).


CONCLUSIONS
Instruments predicting functional adverse outcomes are difficult to compare due to heterogeneity of functional outcomes and hospital settings. The reason why so many tools have been developed is probably because none gives full satisfaction: their general predictive validity and performances are insufficient. Further research is needed to improve the screening of frail older patients admitted to hospital with standardized and validated tools.
De Saint-Hubert
M
M
Cliniques Universitaires de Mont-Godinne, Geriatric Department, UCLouvain, Rue du Dr Therasse, 1-5530 Yvoir. marie.desainthubert@uclouvain.be
Schoevaerdts
D
D
Cornette
P
P
D'Hoore
W
W
Boland
B
B
Swine
C
C
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening; D015596:Nutrition Assessment; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012944:Social Support