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Clinical Changes in Older Adults During Hospitalization: Responsiveness of the inter RAI Acute Care Instrument
Author(s) -
Wellens Nathalie I. H.,
Verbeke Geert,
Flamaing Johan,
Moons Philip,
Boonen Steven,
Tournoy Jos,
Milisen Koen
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12208
Subject(s) - medicine , activities of daily living , cognition , acute care , longitudinal study , hospital discharge , depressive symptoms , hospital admission , physical therapy , psychiatry , health care , pathology , economic growth , economics
Objectives To evaluate the responsiveness of the M inimum D ata S et inter RAI A cute C are ( AC ), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. Design An explorative secondary data‐analysis comparing prospectively collected data with the inter RAI AC before hospitalization, upon admission, and at discharge. Setting Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. Participants The inter RAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). Measurements Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living ( ADL s), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. Results Significant differences in clinical status were found for all five domains, based on the F riedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The G uyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADL s and depressive symptoms. Conclusion In older inpatients, fluctuations in ADL s, cognition, communication, depressive symptoms, and pain can be captured using the inter RAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards.