Predicting Hospital Admission and Prolonged Length of Stay in Older Adults in the Emergency Department: The PRO-AGE Scoring System.

STUDY OBJECTIVE: We developed prediction models for hospital admission and prolonged length of stay in older adults admitted from the emergency department (ED). METHODS: This was a retrospective cohort study of patients aged 70 years or older who visited a geriatric ED in Brazil (N=5,025 visits). We randomly allocated participants to derivation and validation samples in a 2:1 ratio. We then selected 21 variables based on their clinical relevance and generated models to predict the following outcomes: hospital admission and prolonged length of stay, defined as the upper tertile of hospital stay. We used backward stepwise logistic regressions to select our final predictors and developed risk scoring systems based on the relative values of their ß coefficients. RESULTS: Overall, 57% of the participants were women, 31% were hospitalized, and 1% died in the hospital. The upper tertile of hospital stay was greater than 7 days. Hospital admission was best predicted by a model including male sex, aged 90 years or older, hospitalization in the previous 6 months, weight loss greater than or equal to 5% in the previous year, acute mental alteration, and acute functional decline. The prediction of prolonged length of stay retained the same variables, except male sex, which was substituted for fatigue. The final scoring system reached areas under the receiver operating characteristic curve of 0.74 for hospital admission and 0.79 for prolonged length of stay, and their accuracies were confirmed in the validation models. CONCLUSION: The PRO-AGE scoring system predicted hospital admission and prolonged length of stay in older adults with good accuracy, using a simple approach and only 7 easily obtained clinical variables.

Predicting posthospitalization falls in Brazilian older adults: External validation of the Carpenter instrument.

OBJECTIVES: This study sought to explore and externally validate the Carpenter instrument's efficacy in predicting postdischarge fall risk among older adults admitted to the emergency department (ED) for reasons other than falls or related injuries. METHODS: A prospective cohort study was conducted on 779 patients aged ≥ 65 years from a tertiary hospital in São Paulo, Brazil, who were monitored for up to 6 months post-ED hospitalization. The Carpenter instrument, which evaluates the four risk factors nonhealing foot sores, self-reported depression, inability to self-clip toenails, and prior falls, was utilized to assess fall risk. Follow-up by telephone occurred at 30, 90, and 180 days to identify falls and mortality. Fine-Gray models estimated the predictive power of Carpenter instrument for future falls, considering death as a competing event and sociodemographic factors, frail status, and clinical measures as confounders. RESULTS: Among 779 patients, 68 (9%) experienced a fall within 180 days post-ED admission, and 88 (11%) died. The majority were male (54%), with a mean age of 79 years. Upon utilizing the Carpenter score, those with a higher fall risk (≥2 points) displayed more comorbidities, greater frailty, and increased clinical severity at baseline. Regression analyses showed that every additional point on the Carpenter score increased the hazard of falls by 73%. Two primary contributors to its predictive potential were identified: a history of falls in the preceding year and an inability to self-clip toenails. However, the instrument's discriminative accuracy was suboptimal, with an area under the curve of 0.62. CONCLUSIONS: While the Carpenter instrument associated with a higher 6-month postadmission fall risk among older adults post-ED visit, its accuracy for individual patient decision making was limited. Given the significant impact of falls on health outcomes and health care costs, refining risk assessment tools remains essential. Future research should focus on enhancing these assessments and devising targeted proactive strategies.

[Desire for information and participation in therapeutic decisions concerning severe diseases, in patients of a university hospital]. / Desejo de informação e participação nas decisões terapêuticas em caso de doenças graves em pacientes atendidos em um hospital universitário.

BACKGROUND: The purpose of our study was to evaluate the desire of the patients on being informed about diagnosis of severe diseases, the desire to have their families informed about this situation and to participate in therapeutic decisions. METHODS: 363 patients (outpatients and inpatients) of a General Internal Medicine division of a University Hospital were interviewed. The questionnaire contained specific questions on their desire to be informed of the diagnosis in case of cancer or AIDS and on their desire to have their families informed as well. Specific questions on whether they wanted to be informed of and participate of the therapeutic discussion process in case of abdominal tumors were also included. RESULTS: 96.1% of men and 92.6% of women showed the desire of being informed in case of cancer diagnosis and 87.7% of men and 84.2% of women wanted to have their families informed, 94.2% of men and 91% of women wanted to know the diagnosis of AIDS. While 86% of women and 76.6% of men wanted be informed in the case of a diagnosis of an abdominal tumor, only 58.5% of women and 39.6% of men wanted to give their opinion about in the case of different therapeutic alternatives. The desire to participate in therapeutic decisions was significantly lower (p<0.05) in men, people older than 60 years and inpatients. CONCLUSIONS: Our results showed that the great majority of the population that seeks for medical support in a Brazilian university hospital wishes to be informed on this health condition, even in case of serious illness. In addition, there are intense familiar bonds that make patients want to have their families also informed.

Desejo de informação e participação nas decisões terapêuticas em caso de doenças graves em pacientes atendidos em um hospital universitário / Desire of information and participation in therapeutic decisions concerning severe diseases, in patients of a University Hospital

OBJETIVO: Avaliar o desejo de pacientes serem informados sobre diagnóstico de doenças graves, de informação às suas famílias e de participação nas decisões terapêuticas. MÉTODOS: 363 pessoas atendidas no ambulatório ou internadas na enfermaria de um serviço universitário de Clínica Geral foram entrevistadas. O questionário continha perguntas sobre desejo de ser informado e de que familiares também fossem informados em casos de diagnósticos de câncer e síndrome da imunodeficiência adquirida (Aids) e de ser informado e participar de decisões terapêuticas em caso de tumores abdominais. RESULTADOS: Homens (96,1 por cento) e mulheres (92,6 por cento) mostraram desejo de serem informados do diagnóstico de câncer e 87,7 por cento dos homens e 84,2 por cento das mulheres desejaram que sua família também fosse informada; 94,2 por cento dos homens e 91 por cento das mulheres afirmaram querer saber do diagnóstico de Aids. Enquanto 86 por cento das mulheres e 76,6 por cento dos homens mostraram desejo de serem informados das opções terapêuticas em caso de tumor abdominal, apenas 58,5 por cento das mulheres e 39,6 por cento dos homens desejaram opinar sobre o tratamento. O desejo de participar das decisões terapêuticas foi menor nos homens, nas pessoas com mais de 60 anos e em quem estava internado (p<0.05). CONCLUSÕES: A grande maioria da população que procura um hospital universitário deseja ser informada sobre suas condições de saúde, incluindo eventuais diagnósticos de doenças graves. Por outro lado, existem vínculos familiares intensos, sendo que os pacientes desejam, também, que suas famílias sejam informadas.