title: [Predictive value of the VMS theme 'Frail elderly': delirium, falling and mortality in elderly hospital patients].
abstract: OBJECTIVE
  To determine the predictive value of safety management system (VMS) screening questions for falling, delirium, and mortality, as punt down in the VMS theme 'Frail elderly'.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  We selected all patients ≥ 70 years who were admitted to non-ICU wards at the Deventer Hospital, the Netherlands, for at least 24 hours between 28 March 2011 and 10 June 2011. On admission, patients were screened with the VMS instrument by a researcher. Delirium and falls were recorded during hospitalisation. Six months after hospitalisation, data on mortality were collected.
  
  
  RESULTS
  We included 688 patients with a median age of 78.7 (range: 70.0-97.1); 50.7% was male. The sensitivity of the screening for delirium risk was 82%, the specificity 62%. The sensitivity of the screening for risk of falling was 63%, the specificity 65%. Independent predictors for mortality within 6 months were delirium risk (odds ratio (OR): 2.3; 95% CI 1.1-3.2), malnutrition (OR: 2.1; 95% CI 1.3-3.5), admission to a non-surgical ward (OR: 3.0; 95% CI 1.8-5.1), and older age (OR: 1.1; 95%CI 1.0-1.1). Patients classified by the VMS theme 'Frail elderly' as having more risk factors had a higher risk of dying (p < 0.001).
  
  
  CONCLUSIONS
  The VMS screening for delirium is a reasonably reliable instrument for identifying those elderly people with a high risk of developing this condition; the VMS sensitivity for fall risk is moderate. The number of positive VMS risk factors correlates with mortality and may therefore be regarded as a measure of frailty.
authors.affiliation: Deventer Ziekenhuis, afd. Geriatrie, Deventer.
authors.forename: Frederike M M
authors.initials: FM
authors.lastname: Oud
authors.forename: Sophia E J A
authors.initials: SE
authors.lastname: de Rooij
authors.forename: Truus
authors.initials: T
authors.lastname: Schuurman
authors.forename: Karlijn M
authors.initials: KM
authors.lastname: Duijvelaar
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D008297:Male; D009026:Mortality; D009426:Netherlands; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D017751:Safety Management / Q000592:standards* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity