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PROGNOSTIC VALUE OF ADL-ITEMS (ACTIVITIES OF DAILY LIFE) IN PREDICTING FINAL DISCHARGE IN THE OLDER REVALIDATION PATIENT.
Van Esbroeck M, D?Hooghe A, Paridaens K, Vandewoude M,
AIM
The functional profile of patients referred for revalidation is based on a geriatric assessment consisting of the basic ADL-items. This study evaluates the prognostic value of the components of this profile in predicting final discharge.
METHODS
Five hundred consecutive patients referred for geriatric revalidation were prospectively included. The referring centre was asked to score the following ADL-items: dependency for bathing, dressing, transferring, toileting, continence and feeding. Furthermore they classified patients as disoriented or not and suggested a prognosis for discharge. Logistic regression was used on these data to identify significant independent variables. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value of those ADL-items and their odds ratio (OR) for discharge to a nursing home were determined (Table).
RESULTS
In 500 patients (64.4% female; mean age: 80.0 ? 9.38) logistic regression identified 3 ADL-items, scored before revalidation, as independent predictors of discharge: dependency for feeding, incontinence and disorientation. The prognosis for discharge was correct in 74% of the patients going to a nursing home and in 76% of those returning home.
ADL-Item Sensitivity Specificity PPV NPV OR(95%CI)
Feeding dependency 66 53 43 75 2.25(1.48-3.41)
Incontinence 47 72 47 72 2.31(1.52-3.52)
Disorientation 37 87 59 72 3.70(2.29-5.98)
CONCLUSION
Dependency for feeding, incontinence and disorientation were the most reliable ADL-items in predicting final discharge. Other ADL-items are likely to be more responsive to active revalidation.
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