Tom Braes

The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.

Detection of delirium by bedside nurses using the confusion assessment method

A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5‐month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses.

Preventing Delirium in Older Adults with Recent Hip Fracture Through Multidisciplinary Geriatric Consultation

To evaluate the effect of inpatient geriatric consultation teams (IGCTs), which have been introduced to improve the quality of care of older persons hospitalized on nongeriatric wards, on delirium and overall cognitive functioning in older adults with hip fracture.

Fall Prediction in Inpatients by Bedside Nurses Using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) Instrument: A Multicenter Study

OBJECTIVES: To assess the predictive value of the St. Thomass Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument, a simple fall‐risk assessment tool, when administered at a patients hospital bedside by nurses.

Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments

Objectives To compare the abilities of four different screening tools to predict return visits of older persons after they have been discharged from the emergency department (ED). Methods We assessed 83 short-term (discharged within 24u2009h) patients (aged 65 years and above) who visited the ED of the University Hospitals Leuven, Belgium, from 15 October 2005 to 24 December 2005. The Identification of Seniors at Risk (ISAR), the Triage Risk Screening Tool (TRST), the eight-item questionnaire of Runciman, and the seven-item questionnaire of Rowland were administered at admission to screen the patients for risk factors of future ED readmission. By telephone follow-up 14, 30, and 90 days after discharge from the ED, we asked the patients (or their families) whether readmission had occurred since their initial discharge from the ED. Results Readmission rates were 10%, 15.8%, and 32.5% after 14, 30, and 90 days, respectively. When using three or more positive answers as the cutoff scores, the Rowland questionnaire proved to be the most accurate predictive tool with a sensitivity of 88%, specificity of 72%, and negative predictive value of 98% at 14 days after discharge. Thirty days after discharge, the sensitivity was 73%, specificity was 75%, and negative predictive value was 92%. Conclusion Repeat visits in older persons admitted to an ED seemed to be most accurately predicted by using the Rowland questionnaire, with an acceptable number of false positives. This instrument can be easily integrated into the standard nursing assessment.

Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial

OBJECTIVES: To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission.

Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools.

Background and aims: Older hospitalized patients are at risk of functional decline, which is associated with several negative outcomes. The aim of this study was to compare the predictive accuracy of the Identification of Seniors At Risk (ISAR), Variable Indicative for Placement risk (VIP) and the Flemish version of the Triage Risk Screening Tool (TRST) in predicting functional decline. Methods: A prospective cohort study with 30 days follow-up in geriatric, medical and surgical wards in 25 hospitals was conducted. 752 participants aged 75 years or older were eligible for inclusion. Baseline data were gathered within 72 hours of admission. Functional decline was defined as an increase of one point or more from the premorbid Katz score to the score 30 days post-discharge. Positive predictive value (PPV) and negative predictive value (NPV) were calculated on 2×2 tables as well as by Bayes’ theorem. Results: Functional decline at 30 days postdischarge was observed in 279 participants (39%). ISAR and Flemish TRST showed high sensitivity (88%–78%) and fair NPV (62%–67%), but low specificity (19%–30%) and low PPV (47%–48%) using the original cut-off of ≥2. The sensitivity of VIP with cut-off ≥2 was too low (62%), but could be optimized with cut-off ≥1, showing sensitivity, specificity, PPV and NPV of 88%, 21%, 48% and 68%, respectively. Accuracy varied between 40% and 61% for all instruments on all calculated cut-offs. Conclusions: All three instruments performed similarly well, showing good sensitivity and fair NPV, the two major characteristics for good screening tools. False positives could be filtered out according to the clinical expert opinion of a care team.

Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments

Background and aims: Hospital readmission after discharge is an important clinical and health policy issue. We compared the predictive accuracy of the Identification of Seniors at Risk (ISAR), the Flemish version of the Triage Risk Screening Tool (TRST) and Variable Indicative of Placement risk (VIP) assessing unplanned readmissions. Methods: We included 213 patients (≥65 years), hospitalized following admission to the emergency department. The ISAR, TRST and VIP were administered at admission. Unplanned readmissions were registered by telephone follow-up 14, 30 and 90 days post-discharge. Results: Unplanned readmission rates were 6.8%, 14.7% and 23.5% after 14, 30, and 90 days, respectively. The ISAR showed low to moderate sensitivity (54%–69%) and a high negative predictive value (≥78%) at all measurement points. Specificity and positive predictive value were low (≤33% and ≤24%, respectively). The TRST had low to moderate sensitivity (42%–67%) and a high negative predictive value (≥82%). Specificity and positive predictive value were low (≤45% and ≤27%, respectively). The VIP had very low sensitivity (≤26%) and high specificity (≥80%). Its negative predictive value was high (≥79%) and its positive predictive value was low (≤22%). Conclusions: Due to their moderate to low sensitivity, and low specificity and positive predictive value, none of the instruments was capable of accurately predicting unplanned readmission in older, hospitalized patients. Overall, reducing or increasing the original cut-off value by one point did not result in improved performance. Our findings suggest that these instruments lack the necessary sophistication to capture the complexity of (unplanned) readmissions.

Predictie van functionele achteruitgang bij ambulante geriatrische patiënten op de spoedgevallendienst

Prediction of functional decline in elderly patients discharged from the Accident and Emergency departmentAim The aim of this study is to investigate the predictive validity of 5 screening tools with respect to functional decline in older persons discharged from the Accident & Emergency Department. Methods The Identification of Seniors at Risk (ISAR), Triage Risk Screening Tool (TRST), questionnaire of Runciman, questionnaire of Rowland and the Voorlopige Indicator voor Plaatsing (VIP) were collected in 83 older persons discharged from thenEmergency Department of the University Hospitals of Leuven. Functionalndecline was derived from the Katz-scale, reflecting the condition 14 days before admission, at admission, 14, 30 and 90 days after discharge. Results The screening tools with the highest sensitivity and negative predictive value at 14 days after discharge were the questionnaire of Rowland and the ISAR. Thirty and ninety days after discharge, the ISAR was most sensitive and predictive. Conclusion Sensitivity and negative predictive value are thenmost important parameters for screening tools. Hence, our study suggests that the ISAR instrument is the most appropriate instrument to predict functional decline in ambulatory older persons admitted to the emergency department. The ISAR can easily be integrated in nursing records and can be systematically employed in older persons at the emergency department.nTijdschr Gerontol Geriat 2008; 39: 17-26SamenvattingDoel Het doel van deze studie is de predictieve validiteit te onderzoeken van vijf screeningsinstrumenten in het voorspellen van functionele achteruitgang bij ouderen die ambulant verzorgd werden op een spoedgevallendienst. Methode Bij 83 ouderen die ambulant op de spoedgevallendienst van UZ Leuven werden verzorgd, werden de Identification of Seniors at Risk (ISAR), Triage Risk Screening Tool (TRST), de vragenlijst van Runciman, de vragenlijst van Rowland en de Voorlopige Indicator voor Plaatsing (VIP) afgenomen. De functionele status 14 dagen voor opname, bij opname, en 14, 30 en 90 dagen na ontslag werd in kaart gebracht met behulp van de Katz schaal. Resultaten De screeningsinstrumenten met de beste verhouding tussen de sensitiviteit en negatief predictieve waarde 14 dagen na ontslag zijn de vragenlijst van Rowland en de ISAR. Dertig en negentig dagen na ontslag is dit de ISAR. Conclusie Uit dit onderzoek blijkt dat, in aanmerking genomen dat voor een screeningsinstrument de sensitiviteit en negatief predictieve waarde de belangrijkste parameters zijn, de ISAR het meest geschikte instrument is om functionele achteruitgang bij ouderen na een ambulante verzorging op de spoedgevallendienst te voorspellen. De ISAR is eenvoudig in het verpleegdossier te integreren en kan standaard bij elke patiënt op de spoedgevallendienst afgenomen worden.AIMnThe aim of this study is to investigate the predictive validity of 5 screening tools with respect to functional decline in older persons discharged from the Accident & Emergency Department.nnnMETHODSnThe Identification of Seniors at Risk (ISAR), Triage Risk Screening Tool (TRST), questionnaire of Runciman, questionnaire of Rowland and the Voorlopige Indicator voor Plaatsing (VIP) were collected in 83 older persons discharged from the Emergency Department of the University Hospitals of Leuven. Functional decline was derived from the Katz-scale, reflecting the condition 14 days before admission, at admission, 14, 30 and 90 days after discharge.nnnRESULTSnThe screening tools with the highest sensitivity and negative predictive value at 14 days after discharge were the questionnaire of Rowland and the ISAR. Thirty and ninety days after discharge, the ISAR was most sensitive and predictive.nnnCONCLUSIONnSensitivity and negative predictive value are the most important parameters for screening tools. Hence, our study suggests that the ISAR instrument is the most appropriate instrument to predict functional decline in ambulatory older persons admitted to the emergency department. The ISAR can easily be integrated in nursing records and can be systematically employed in older persons at the emergency department.

GERIATRICS ON THE RUN: RATIONALE, IMPLEMENTATION, AND PRELIMINARY FINDINGS OF A BELGIAN INTERNAL LIAISON TEAM

Abstract This article describes the rationale, implementation, interventions and preliminary findings of a Belgian interdisciplinary internal liaison team in a 1470-bed teaching hospital. The motive to start the team was threefold: the ageing of the inhospital population, the conclusion that health care professionals working on non-geriatric wards often lack the necessary skills to deal with older patients’ needs and Belgian law, obliging each general hospital to set up an internal liaison team. Our team aims at detecting geriatric patients at risk, assisting health care professionals in caring for older patients and sensitizing them regarding optimal geriatric care. The article explains the underlying philosophy and strategy for implementation, focusing on the concepts of reciprocity, flexibility and cooperation. The preliminary results are based on a process evaluation of 719 consultations carried out from November 2004 to November 2006, a time registration, and a Strengths, Weaknesses, Opportunities, and Threats analysis (SWOT). Although our data are preliminary and the implementation of the team was pragmatic rather than research driven, they provide insight into the development, implementation, functioning and interventions of a Belgian interdisciplinary internal liaison team.