Main Article Content

Authors

Background:
Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge


Objective:
This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than 65 receiving management in an acute geriatric care unit in Colombia.


Methods:
This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with the Barthel index measured at admission and discharge. The evaluation discriminates ability and calibration, two fundamental aspects of the scales.


Results:
Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60.


Conclusion:
This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Diego Andrés Chavarro-Cavajal, Pontificia Universidad Javeriana

orcid_id14.png https://orcid.org/0000-0002-8584-3191

Damaris Catherine Sanchez, Pontificia Universidad Javeriana, Facultad de Medicina, Instituto de Envejecimiento, Bogotá, Colombia

orcid_id14.png https://orcid.org/0000-0001-6952-6121

Maria Paula Vargas-Beltrán, Pontificia Universidad Javeriana, Facultad de Medicina, Instituto de Envejecimiento, Bogotá, Colombia. Pontificia Universidad Javeriana, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia. Hospital Universitario San Ignacio, Unidad de Geriatría, Bogotá, Colombia.

orcid_id14.png https://orcid.org/0000-0002-7470-3054

Luis Carlos Venegas-Sanabria, Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud. Bogotá, Colombia . Hospital Universitario Mayor - Méderi, Bogotá, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8260-9108

Oscar Mauricio Muñoz, Pontificia Universidad Javeriana, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia. Hospital Universitario San Ignacio, Departamento de Medicina Interna, Bogotá, Colombia.

orcid_id14.png https://orcid.org/0000-0001-5401-0018

Chavarro-Cavajal, D. A., Sanchez, D. C., Vargas-Beltrán, M. P., Venegas-Sanabria, L. C., & Muñoz, O. M. (2023). Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia. Colombia Medica, 54(1), e2005304. https://doi.org/10.25100/cm.v54i1.5304

Yoo HW, Kim MG, Oh DN, Hwang JH, Lee KS. Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital. Asian Nurs Res (Korean Soc Nurs Sci). 2019 Aug 1;13(3):192-9. https://doi.org/10.1016/j.anr.2019.05.001 PMid:31146026

Aubert CE, Folly A, Mancinetti M, Hayoz D, Donzé JD. Performance-based functional impairment and readmission and death: a prospective study. BMJ Open [Internet]. 2017 Jun 1 [cited 2023 Mar 22];7(6):e016207. https://doi.org/10.1136/bmjopen-2017-016207 PMid:28600376 PMCid:PMC5726050

Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Risk factors for hospital readmission in older adults within 30 days of discharge - a comparative retrospective study. BMC Geriatr [Internet]. 2020 Dec 1 [cited 2023 Mar 22];20(1):1-12. https://doi.org/10.1186/s12877-020-01867-3 PMid:33176721 PMCid:PMC7659222

Castelblanco-Toro SM, Suárez-Acosta AM, Sánchez-Plazas D, Coca-León DJ, Chavarro-Carvajal DA. Prevalence of hospital functional impairment in a colombian elderly population at the san ignacio university hospital. Revista Ciencias de la Salud. 2019;17(3):20-30. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8354

Dent E, Perez-Zepeda M. Comparison of five indices for prediction of adverse outcomes in hospitalised Mexican older adults: A cohort study. Arch Gerontol Geriatr. 2015 Jan 1;60(1):89-95. https://doi.org/10.1016/j.archger.2014.09.011 PMid:25307954

Sager MA, Rudberg MA, Jalaluddin M, Franke T, Inouye SK, Seth Landefeld C, et al. Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization. J Am Geriatr Soc [Internet]. 1996 Mar 1 [cited 2023 Mar 22];44(3):251-7 https://doi.org/10.1111/j.1532-5415.1996.tb00910.x PMid:8600192

McCusker J, Bellavance F, Cardin S, Trépanier S, Verdon J, Ardman O. Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool. J Am Geriatr Soc [Internet]. 1999 Oct 1 [cited 2023 Mar 22];47(10):1229-37. https://doi.org/10.1111/j.1532-5415.1999.tb05204.x PMid:10522957

Galvin R, Gilleit Y, Wallace E, Cousins G, Bolmer M, Rainer T, et al. Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool. Age Ageing [Internet]. 2017 Mar 1 [cited 2023 Mar 22];46(2):179-86. Available from: https://academic.oup.com/ageing/article/46/2/179/2712560

Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front Public Health. 2018 Jun 11;6:149. https://doi.org/10.3389/fpubh.2018.00149 PMid:29942800 PMCid:PMC6004510

Altman DG, Vergouwe Y, Royston P, Moons KGM. Prognosis and prognostic research: validating a prognostic model. BMJ [Internet]. 2009 May 28 [cited 2023 Mar 22];338(7708):1432-5. https://doi.org/10.1136/bmj.b605 PMid:19477892

Moons KGM, Wolff RF, Riley RD, Whiting PF, Westwood M, Collins GS, et al. PROBAST: A tool to assess risk of bias and applicability of prediction model studies: Explanation and elaboration. Ann Intern Med. 2019 Jan 1;170(1):W1-33. https://doi.org/10.7326/M18-1377 PMid:30596876

Wolff RF, Moons KGM, Riley RD, Whiting PF, Westwood M, Collins GS, et al. PROBAST: A tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med. 2019 Jan 1;170(1):51-8. https://doi.org/10.7326/M18-1376 PMid:30596875

Izquierdo M, Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Sáez De Asteasu ML, Lucia A, et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med [Internet]. 2019 Jan 1 [cited 2023 Mar 22];179(1):28-36. https://doi.org/10.1001/jamainternmed.2018.4869 PMid:30419096 PMCid:PMC6583412

Mahoney FI BDW. Functional evaluation: the Barthel Index. Md State Med J. 1965 Feb;14:61-5. https://doi.org/10.1037/t02366-000

Lawton MP BEM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179 PMid:5349366

Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric PracticeDeveloping the Short-Form Mini-Nutritional Assessment (MNA-SF). The Journals of Gerontology: Series A [Internet]. 2001 Jun 1 [cited 2023 Mar 22];56(6):M366-72. https://doi.org/10.1093/gerona/56.6.M366 PMid:11382797

Tobar E, Romero C, Galleguillos T, Fuentes P, Cornejo R, Lira MT, et al. Confusion assessment method for diagnosing delirium in ICU patients (CAM-ICU): Cultural adaptation and validation of the Spanish version. Med Intensiva. 2010;4(1):4-13. https://doi.org/10.1016/j.medin.2009.04.003 PMid:19819041

Rosselli D, Ardila A, Pradilla G, Morillo L, Bautista L, Rey O, et al. [The Mini-Mental State Examination as a selected diagnostic test for dementia: a Colombian population study. GENECO]. Rev Neurol. 2000;30(5):428-32. https://doi.org/10.33588/rn.3005.99125 PMid:10775968

Royston P, Moons KGM, Altman DG, Vergouwe Y. Prognosis and prognostic research: Developing a prognostic model. BMJ [Internet]. 2009 Mar 31 [cited 2023 Mar 23];338(7707):1373-7. https://doi.org/10.1136/bmj.b604 PMid:19336487

Hosmer DW, Lemeshow S. Assessing the Fit of the Model. Applied Logistic Regression [Internet]. 2005 Jan 28 [cited 2023 Mar 23];143-202. https://doi.org/10.1002/0471722146.ch5

Torres LA, Rivera SM, Mendivelso FO, Yomayusa N, Cardenas HM, Hernandez C. Análisis del riesgo de deterioro funcional y sociofamiliar en el adulto mayor hospitalizado. Revista Médica Sanitas. 2019 Mar 30;22(1):6-16. https://doi.org/10.26852/01234250.30

Liu SK, Ward M, Montgomery J, Mecchella JN, Masutani R, Bartels SJ, et al. Association of Hospital Admission Risk Profile Score with Mortality in Hospitalized Older Adults. Innov Aging [Internet]. 2017 Mar 1 [cited 2023 Mar 23];1(1):1-9. https://doi.org/10.1093/geroni/igx007

Liu SK, Montgomery J, Yan Y, Mecchella JN, Bartels SJ, Masutani R, et al. Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults. J Am Geriatr Soc [Internet]. 2016 Oct 1 [cited 2023 Mar 23];64(10):2095-100. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14345 https://doi.org/10.1111/jgs.14345 PMid:27602551 PMCid:PMC5073021

Hoogerduijn JG( 1 ), Schuurmans MJ( 2 ), Korevaar JC( 3 ), Buurman BM( 4 ), de Rooij SE( 4,5 ). Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments. Journal of Clinical Nursing [Internet]. 2010 May 1 [cited 2023 Mar 28];19(9-10):1219-1225-1225. https://doi.org/10.1111/j.1365-2702.2009.03035.x PMid:20345834

García-Pérez L, Linertová R, Lorenzo-Riera A, Vázquez-Díaz JR, Duque-González B, Sarría-Santamera A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM: An International Journal of Medicine [Internet]. 2011 Aug 1 [cited 2023 Mar 23];104(8):639-51. https://doi.org/10.1093/qjmed/hcr070 PMid:21558329

Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Cadore EL, Galbete A, et al. Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: Secondary analysis of a randomized trial. PLoS Med. 2019 Jul 1;16(7). https://doi.org/10.1371/journal.pmed.1002852 PMid:31276501 PMCid:PMC6611563

De Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2007. https://doi.org/10.1002/14651858.CD005955 PMid:17182667

Downloads

Download data is not yet available.
Received 2022-06-17
Accepted 2023-03-30
Published 2023-07-27