Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: The SAFES cohort study

Dramé, Moustapha; Jovenin, Nicolas; Novella, J.-L.; Lang, Pierre Olivier; Somme, Dominique; Lanièce, Isabelle; Voisin, Thierry; Blanc, P.; Couturier, Pascal; Gauvain, Jean-Bernard; Blanchard, F.; Jolly, Damien

doi:10.1007/bf02983207

Cited by 60 publications

(63 citation statements)

References 28 publications

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“…Nonetheless, higher comorbidity, poor functional and nutritional status were factors that negatively affected survival. Similarly to our results, previous studies have shown that worse functional status prior to and at hospital admission is associated with a higher short and long-term mortality (32,33) as well as higher comorbidity scores and worse nutritional status (34,35).…”

Section: Discussionsupporting

confidence: 91%

Telomere length, comorbidity, functional, nutritional and cognitive status as predictors of 5 years post hospital discharge survival in the oldest old

Zekry

Krause

Irminger-Finger

et al. 2011

J Nutr Health Aging

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Section: Discussionsupporting

confidence: 91%

Telomere length, comorbidity, functional, nutritional and cognitive status as predictors of 5 years post hospital discharge survival in the oldest old

Zekry

Krause

Irminger-Finger

et al. 2011

J Nutr Health Aging

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“…10,37,64,69,73 Assessing prognostic accuracy for these instruments at different thresholds did not improve on the summary estimates of accuracy from our meta-analysis. In addition, one trial reported sufficient detail to compute interval likelihood ratios (iLR).…”

Section: Screening Instrumentsmentioning

confidence: 60%

“…[37][38][39][40][41] The outcomes assessed included mortality at 6 weeks to 2 years and institutionalization at 1 year. The variables assessed included malnutrition, age, functional limitations and dependency, presence of severe comorbidities, balance issues, number of offspring, living situation, and the presence of delirium or dementia.…”

Section: Individual Risk Factorsmentioning

confidence: 99%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

253

213

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Objectives: A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.Methods: A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical testtreatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.Results: A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR-= 0.27) and nursing home placement (LR-= 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR-range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Conclusions: Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the r...

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“…[16][17][18][19][20][21][22][23][24][25][26][27] Although none of these tools is clearly superior, the system developed by Walter and colleagues 16 has been externally validated, 28,29 has good predictive accuracy (C statistic 0.79) and incorporates easily obtainable information from multiple relevant domains ( Figure 1). 16 This tool provides an estimate of 1-year mortality for groups of patients similar to a physician's specific patient.…”

Section: Age ≥ 55 Years and 1 Or More Of The Following Advanced Chronmentioning

confidence: 99%

Just ask: discussing goals of care with patients in hospital with serious illness

You

Fowler

Heyland

2013

CMAJ

100

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CMAJ, April 1, 2014, 186(6) 425 O ur population is aging, and older patients are living longer with chronic illness. Technology-laden end-of-life care is associated with poorer quality of life, lower satisfaction with care and increased anxiety and depression for family members.1 Ad vance care planning can increase the quality of life of dying patients, improve the experience of family members and decrease health care costs. 1-3Advance care planning is a process by which patients consider options for future health care decisions and identify their wishes. These decisions and wishes can vary depending on the setting. For example, during an acute stay in hospital, the plan may pertain to the goals of care for the current stay in addition to any care that may be required after discharge. In other settings, the plan may result in an advance care directive -a verbal or written instruction de scribing what kind of care a patient would want (or not want) if he or she were no longer able to speak for him or herself, and the values that guide the patient in making important health care decisions. Advance care planning may also result in the nomination of a substitute decision-maker -someone who makes decisions for the pa tient if the patient is incapable of doing so.Patients in hospital with serious illness and their family members have identified improvements in end-of-life communication and decision-making as high-priority targets for quality improvement; 4,5 however, hospital-based health care providers infrequently engage patients and families in such conversations.6 Accordingly, the focus of our review is to provide guidance for advance care planning as it pertains to the inpatient setting (i.e., determination of goals of care for the patient in hospital). Although health care providers in the outpatient setting (e.g., family physicians, consultant physicians) play a key role in advance care planning, hospital-based providers share this responsibility. In fact, a stay in hospital presents an important opportunity for engaging in discussions about goals of care, because it signals a change in the trajectory of the patient's illness, giving in creased relevance to these conversations, and because potential substitute decision-makers (e.g., the most involved family members) are often present.To organize our review, we use a communication and decision-making framework consisting of the following components: identifying patients at high risk of dying who need to have a discussion about goals of care; information exchange (regarding prognosis, values, and the risks and expected outcomes of various treatment options); and reaching a decision through discussion and deliberation.7 By providing structured guidance, specific advice and practical tools, our aim is to increase clinicians' confidence in engaging in meaningful end-of-life communication with patients in hospital and their family members. To inform this review, we drew on a broad range of evidence, from expert opinion to randomized controlled trials and systematic...

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Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: The SAFES cohort study

Cited by 60 publications

References 28 publications

Telomere length, comorbidity, functional, nutritional and cognitive status as predictors of 5 years post hospital discharge survival in the oldest old

Telomere length, comorbidity, functional, nutritional and cognitive status as predictors of 5 years post hospital discharge survival in the oldest old

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Just ask: discussing goals of care with patients in hospital with serious illness

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