Julie Frances Daltrey, Michal Kathleen Boyd, Vanessa Burholt, Heather McLeod, W. U. Zhenqiang, Katherine Bloomfield, Jacqualine Robinson
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A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Nine variables were independently associated with acute deterioration. These were being ‘largely asleep or unresponsive’ odds ratio (OR): 7.95, 95% CI: 4.72–13.39, <i>p</i> < 0.001, ‘easily distracted’ (OR: 1.78, 95% CI: 1.28–2.49, <i>p</i> < 0.001), eating ‘one or fewer meals a day’ (OR: 2.13, 95% CI: 1.67–2.73, <i>p</i> < 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11–3.82, <i>p</i> = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24–3.03, <i>p</i> = 0.004), ‘dyspnoea; at rest’ (OR: 1.81, 95% CI: 1.32–2.49, <i>p</i> < 0.001), ‘two or more falls in 30 days’ (OR: 1.53, 95% CI: 1.15–2.03, <i>p</i> = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07–1.77, <i>p</i> = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05–1.77, <i>p</i> = 0.019).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>Not applicable.</p>\n </section>\n </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70068","citationCount":"0","resultStr":"{\"title\":\"Association of Clinical Indicators of Acute Deterioration and Morbidity and Mortality in the Residential Aged Care Population: A Retrospective Cohort Study of Routinely Collected Health Data\",\"authors\":\"Julie Frances Daltrey, Michal Kathleen Boyd, Vanessa Burholt, Heather McLeod, W. U. 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引用次数: 0
摘要
及时识别居住在养老院的人的急性恶化是降低住院发病率和死亡率的关键。然而，住院医生经常出现非典型或非特异性的表现，这使得这很困难。本研究旨在量化文献中报道的急性恶化指标与发病率和死亡率之间关系的强度。方法采用常规收集的健康资料进行回顾性队列研究。单一依赖急性恶化变量（最后一次完成国际住院医师评估工具长期护理设施（interRAI-LTCF）评估后7天内的急诊科就诊或住院或死亡）与文献中报告的急性恶化指标相关，并且在interRAI-LTCF中可用。单因素和多因素logistic回归分析评估了这种关联。结果9个变量与急性恶化独立相关。这些风险分别是“大部分时间处于睡眠状态或无反应”，优势比（or）： 7.95, 95% CI: 4.72-13.39, p < 0.001，“容易分心”（or: 1.78, 95% CI: 1.28-2.49, p < 0.001），“每天只吃一餐或少餐”（or: 2.13, 95% CI: 1.67-2.73, p < 0.001），日常生活活动减少（or: 2.06, 95% CI: 1.11-3.82, p = 0.02），无法完成如厕（or: 1.95, 95% CI: 1.24-3.03, p = 0.004），“呼吸困难”；“休息时”（OR: 1.81, 95% CI: 1.32-2.49, p = 0.001），“30天内两次或两次以上跌倒”（OR: 1.53, 95% CI: 1.15-2.03, p = 0.003），外周水肿（OR: 1.37, 95 CI: 1.07-1.77, p = 0.014）和每日疼痛（OR: 1.37, 95% CI: 1.05-1.77, p = 0.019）。结论：呈现9个变量中的一个使居民比其他居住在该设施的人更有1.4到8倍的可能性经历急性恶化。医疗助理对这些变量的监测有助于及时识别急性恶化。试验注册不适用。
Association of Clinical Indicators of Acute Deterioration and Morbidity and Mortality in the Residential Aged Care Population: A Retrospective Cohort Study of Routinely Collected Health Data
Introduction
The timely identification of acute deterioration in people living in residential aged care is critical to reducing rates of resident morbidity and mortality. However, residents often present with atypical or nonspecific presentations that make this difficult. This study aimed to quantify the strength of the relationship between the indicators acute deterioration reported in the literature and morbidity and mortality.
Method
A retrospective cohort study using routinely collected health data. A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association.
Results
Nine variables were independently associated with acute deterioration. These were being ‘largely asleep or unresponsive’ odds ratio (OR): 7.95, 95% CI: 4.72–13.39, p < 0.001, ‘easily distracted’ (OR: 1.78, 95% CI: 1.28–2.49, p < 0.001), eating ‘one or fewer meals a day’ (OR: 2.13, 95% CI: 1.67–2.73, p < 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11–3.82, p = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24–3.03, p = 0.004), ‘dyspnoea; at rest’ (OR: 1.81, 95% CI: 1.32–2.49, p < 0.001), ‘two or more falls in 30 days’ (OR: 1.53, 95% CI: 1.15–2.03, p = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07–1.77, p = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05–1.77, p = 0.019).
Conclusion
Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration.
期刊介绍：
The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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