PREDICTING THE OUTCOME IN ELDERLY PATIENTS OF HOSPITAL ADMISSION FOR ACUTE-CARE IN PARIS, FRANCE - CONSTRUCTION AND INITIAL VALIDATION OF ASIMPLE INDEX

Objective - To develop a simple index able to identify at an early sta ge those elderly patients at high risk of requiring discharge to a res idential or nursing home after admission to hospital for acute care. F or these patients, early discharge planning might lead to a more effec tive management and reduce the length of hospitalisation. Design, sett ing, and patients - This was a prospective study conducted in two teac hing hospitals in Paris, France. A total of 510 consecutive patients w as included. They were aged 75 years or more and had been admitted to acute medical care units through the emergency department. Measurement s - Demographic data, social support, physical disability, mental disa bility, and pathologic status were assessed shortly after admission (w ithin 24-48 hours). Main outcome measures - Outcome of hospitalisation was defined as discharge to home or residential/nursing home. Results - The index, developed by multiple logistic regression, included six variables: the wish of patients' principal carer about their returning home after acute hospitalisation, presence of a chronic condition, ab ility to perform toileting, ability to know the name of the hospital o r the city, their age, and their Living arrangements. The sensitivity of the index in identifying patients at high risk of requiring dischar ge to a residential/nursing home was 74.4%, the specificity 63.8%, the positive predictive value was 57.8%, and the negative predictive valu e was 80.6%. Conclusions - The simple index, using data available very early in the course of hospitalisation, provides an accurate predicti on of the hospitalisation outcome. The performance of the index should be tested in other populations and the practical benefits of risk scr eening should be assessed in a controlled trial to evaluate whether th e intervention is useful and without any adverse effects.