Prognostic Value of Braden Activity Subscale for Mobility Status in Hospitalized Older Adults

Abstract

OBJECTIVES To evaluate the predictive value of the Activity subscale of the Braden Scale for Predicting Pressure Sore Risk in assessing mobility impairment and recovery among hospitalized older adults. DESIGN Retrospective cohort study. SETTING UF Health Shands Hospital, University of Florida, Gainesville, Florida. PATIENTS 19,769 older adults (≥65 years) hospitalized between January 2009 and April 2014. MEASUREMENTS Incident mobility impairment and recovery were assessed with the Braden Activity subscale (BAS) score that nurses use to grade patients at every shift change (~3 times/d). Posthospital mortality rate and discharge disposition were used to assess the prognostic value of the BAS. RESULTS Of the 10,717 study patients observed “walking frequently” at admission, 2218 (20.7%) developed incident mobility impairment. Of the other 9052 study patients, who were impaired at admission, 4734 (52.3%) recovered to a state of walking occasionally or frequently. Older adults who developed mobility impairment during hospitalization had an odds of death higher than that of those who remained mobile (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08–1.39). This effect predominately occurred within the first 6 follow-up months. Older adults who recovered from mobility impairment had an odds of death lower than that of those who did not recover mobility in the hospital (OR, 0.54; 95% CI, 0.49–0.59). This effect was slightly stronger within the first 6 months after hospitalization. CONCLUSIONS Nurses’ BAS assessment of mobility status during hospitalization provides substantial prognostic value in hospitalized older adults. The BAS could be an efficient and valuable source of information about mobility status for targeting posthospital care of older adults.

Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review

“…Odds ratios, risk ratios, hazard ratios, and linear regression beta coefficients were reported when available. The final study population consisted of 30 studies . The quality and methodologies of the studies were assessed using adapted criteria from the Cochrane Handbook .…”

“…Studies have shown that the FIM is a better predictor of 30‐day readmission compared to comorbidity indices alone . Recent research has also highlighted the importance of early mobility, and there is increasing interest to see whether functional status measures in the acute care setting are significant predictors of various hospital outcomes . Just as functional status plays a central role in the rehabilitation setting, it may be important to include functional assessment as a more routine part of acute hospital evaluation as well.…”

Braden Scale for Assessing Pneumonia After Acute Ischaemic Stroke

“…Hoffmann et al [24], Ji et al [25] and Smith et al [26]. The other available models for predicting poststroke pneumonia showed worse performance or over-fitting of the model because of their smaller sample sizes, and they often include too many predictors based on the event per variable rule [6,19,[27][28][29][30].…”

Braden Scale for Assessing Pneumonia After Acute Ischaemic Stroke

“…These three models were derived from and mostly validated in large stroke registries. The other available models for the prediction of post-stroke pneumonia were mostly tested in a smaller number of patients, and often too many predictors were included according to the events per-variable rule, which can lead to worse performance and overfitting of the model [6,19,[27][28][29][30].…”