Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward
Abstract
:1. Introduction
2. Methods and Materials
2.1. Study Design
2.2. Sample
2.3. Ethics Approval
2.4. Data Collection and Outcomes
2.5. Measures
2.6. Data Analysis
3. Results
3.1. Relationship between Instruments and Clinical Stability or Decline
3.1.1. Correlations
3.1.2. Associations
3.2. Relationship between Instrument Scores on Admission and Risk of Institutionalisation, Hospitalisation and Death
3.2.1. Institutionalisation
3.2.2. Hospitalisation
3.2.3. Death
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Stable | Ability to eat and drink returned (if previously diminished) Mental status considered normal or back to previous status if recently changed Functionally returning to their usual activities of daily living either independently or with support Improvements in emotional/psychological state or no evidence of deterioration No subsequent events in the last 30 days. |
Unstable | Reduced or inadequate oral and/or nutritional intake Gradual cognitive decline or change in mental state Functionally unable to undertake their normal activities of daily living Social care needs exceeding supports within the home Secondary event resulting in above |
Deteriorating | Increase in events and episodes (set of services provided to treat a clinical condition or procedure) Decrease in function and mobility (activities of daily living) Deterioration in mental status Further weight loss despite interventions |
Admission to CVW | CVW Selection |
---|---|
Diagnosis of frailty with evidence of at least one of the following:
| Red CVW Event(s) occurred in the last 30 days or the patient was discharged from hospital in the last 30 days |
Amber CVW Event(s) occurred >30 days with evidence of more gradual decline in the last 3 months | |
Green CVW Admission to the green VW can only occur following a period of monitoring either in the Red or Amber CVW. Admission to this ward is part of enhanced discharge planning including members of the primary care team and/or Specialist Geriatric Services. |
Variable | Number (%)/ Mean and Standard Deviation (SD) |
---|---|
Demographics Age (years) | 82.83 (SD 6.406) |
Sex | |
Female | 58 (65.9) |
Male | 30 (34.1) |
Living Alone | |
Yes | 33 (37.5) |
No | 55 (62.5) |
Co-morbidity Number of co-morbidities | 2.82 (SD 1.034) |
Number of medications | 8.24 (SD 3.655) |
Number of falls (last 3 months) | |
No Falls | 37 (42) |
1 Fall | 20 (22.7) |
2 or More | 31 (35.2) |
Incontinence | |
Yes | 64 (72.7) |
No | 24 (27.3) |
Unscheduled Healthcare Utilisation Unplanned admissions (3 months prior to CVW admission) | |
1 hospital admission | 36 (40.9) |
2 or more hospital admissions | 21 (23.9) |
Emergency Department Presentations (last 3 months) | |
1 ED presentation | 36 (40.9) |
2 or more ED presentations | 31 (35.2) |
Signs of Self-Neglect | |
Yes | 44 (51.1) |
No | 42 (48.9) |
Risk-Screening Tool | Cut-Off Scores |
---|---|
Rockwood Clinical Frailty Scale | 3 |
Timed up and Go Test | >13 s |
Modified Functional Independence Measure | >1 |
Modified Barthel Index | 16 |
Walsall Pressure Ulcer Risk Tool | >3 |
Malnutritional Universal Screening Tool | 0 |
Mini Mental State Examination | 25 |
Geriatric Depression Scale | 4 |
Identification of Seniors at Risk tool | ≥2 |
Risk Scores | Correlation (r) | p Value |
---|---|---|
60 days | ||
Rockwood CFS | 0.57 | <0.001 *** |
Walsall | 0.59 | <0.001 *** |
Mobility (FIM) | 0.56 | <0.001 *** |
MUST | 0.22 | 0.039 * |
TUG | 0.15 | 0.154 |
ISAR | 0.44 | <0.001 *** |
MMSE | 0.26 | 0.015 * |
Barthel | 0.54 | <0.001 *** |
GDS | 0.09 | 0.431 |
90 days | ||
Rockwood CFS | 0.44 | <0.001 *** |
Walsall | 0.68 | <0.001 *** |
Mobility (FIM) | 0.58 | <0.001 *** |
MUST | 0.32 | 0.002 ** |
TUG | 0.09 | 0.393 |
ISAR | 0.45 | <0.001 *** |
MMSE | 0.46 | <0.001 *** |
Barthel | 0.60 | <0.001 *** |
GDS | 0.01 | 0.947 |
Risk Scores | Odds Ratio | Lower 95% CI | Upper 95% CI | p Value |
---|---|---|---|---|
60 days | ||||
Rockwood CFS | 1.77 | 0.79 | 22 | 0.960 |
Walsall | 4.92 ^ | 2.48 | 9.74 | <0.001 *** |
Mobility (FIM) | 2.97 ^ | 1.81 | 4.86 | <0.001 *** |
MUST | 1.73 | 1.01 | 2.98 | 0.049 * |
TUG | 1.09 | 0.74 | 1.62 | 0.669 |
ISAR | 3.25 ^ | 1.84 | 5.74 | <0.001 *** |
MMSE | 2.08 | 1.11 | 3.92 | 0.02 * |
Barthel | 6.41 ^ | 2.77 | 14.8 | <0.001 *** |
GDS | 1.40 | 0.83 | 2.38 | 0.213 |
90 days | ||||
Rockwood CFS | 3.29 ^ | 1.55 | 6.99 | 0.002 ** |
Walsall | 8.86 ^ | 3.48 | 22.5 | <0.001 *** |
Mobility (FIM) | 3.08 ^ | 1.89 | 5.03 | <0.001 *** |
MUST | 2.33 ^ | 1.24 | 4.35 | 0.008 ** |
TUG | 1.03 ^ | 0.78 | 1.35 | 0.849 |
ISAR | 3.07 ^ | 1.75 | 5.40 | <0.001 *** |
MMSE | 4.23 ^ | 1.98 | 9.07 | <0.001 *** |
Barthel | 7.73 ^ | 3.20 | 18.6 | <0.001 *** |
GDS | 1.08 ^ | 0.62 | 1.91 | 0.778 |
Baseline Risk Scores | OR | 95 CI Lower | 95 CI Upper | p Value |
---|---|---|---|---|
Institutionalisation | ||||
Rockwood CFS | 2.29 | 1.02 | 5.16 | 0.045 * |
Walsall | 2.00 | 1.20 | 3.33 | 0.008 ** |
Mobility (FIM) | 1.19 | 0.98 | 1.43 | 0.080 |
MUST | 0.84 | 0.48 | 1.46 | 0.530 |
TUG | 1.27 | 1.03 | 1.57 | 0.023 * |
ISAR | 1.47 | 0.91 | 2.37 | 0.118 |
MMSE | 1.12 | 0.59 | 2.14 | 0.722 |
Barthel | 1.70 | 0.88 | 3.26 | 0.114 |
GDS | 1.20 | 0.70 | 2.06 | 0.515 |
Hospitalisation | ||||
Rockwood CFS | 1.30 ^ | 0.56 | 3.01 | 0.542 |
Walsall | 0.79 | 0.48 | 1.29 | 0.347 |
Mobility (FIM) | 0.98 | 0.79 | 1.23 | 0.890 |
MUST | 0.77 | 0.40 | 1.50 | 0.440 |
TUG | 1.29 | 1.01 | 1.65 | 0.039 * |
ISAR | 1.55 | 0.87 | 2.77 | 0.137 |
MMSE | 1.13 | 0.53 | 2.41 | 0.749 |
Barthel | 0.73 | 0.35 | 1.54 | 0.407 |
GDS | 1.42 | 0.75 | 2.68 | 0.283 |
Death | ||||
Rockwood CFS | 2.80 | 1.18 | 8.23 | 0.049 * |
Walsall | 1.69 | 0.83 | 3.46 | 0.150 |
Mobility (FIM) | 1.12 | 0.87 | 1.43 | 0.390 |
MUST | 0.83 | 0.37 | 1.86 | 0.651 |
TUG | 0.92 | 0.69 | 1.23 | 0.561 |
ISAR | 1.69 | 0.84 | 3.43 | 0.144 |
MMSE | 3.16 | 1.09 | 9.12 | 0.034 * |
Barthel | 2.75 | 1.04 | 7.25 | 0.041 * |
GDS | 1.10 | 0.53 | 2.29 | 0.800 |
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Lewis, C.; O’Caoimh, R.; Patton, D.; O’Connor, T.; Moore, Z.; Nugent, L.E. Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward. Int. J. Environ. Res. Public Health 2021, 18, 5601. https://doi.org/10.3390/ijerph18115601
Lewis C, O’Caoimh R, Patton D, O’Connor T, Moore Z, Nugent LE. Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward. International Journal of Environmental Research and Public Health. 2021; 18(11):5601. https://doi.org/10.3390/ijerph18115601
Chicago/Turabian StyleLewis, Clare, Rónán O’Caoimh, Declan Patton, Tom O’Connor, Zena Moore, and Linda E. Nugent. 2021. "Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward" International Journal of Environmental Research and Public Health 18, no. 11: 5601. https://doi.org/10.3390/ijerph18115601