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Relevance: Responding to Changing Population Needs.
The elderly population is growing and represents an increasing proportion of elderly admitted to a short stay unit in an emergency department (ED). One month after admission a fifth of the elderly patients have low physical ability and therefore a need for post discharge rehabilitation. Until now screening-tools have been based on self-reported information; a challenge as elderly might be confused or unrealistic about their physical abilities.
Ethics approval
The Regional Scientific Ethical Committees for Southern Denmark has decided that no approval is needed.
The study aimed to evaluate if the 30 Second Chair Stand test (30s-CST) combined with other variables was able to predict rehabilitation needs among acutely admitted elderly patient. Low physical ability were defined as a 30s-CST–score ≤ 8 one month after admission.
The objectives were 1: What risk factors support the 30s-CST identifying elderly with rehabilitation needs? 2: Does the De Morton Mobility Index (DEMMI) add additional predictive value?
In this prospective cohort study elderly (65+years) admitted to the ED at weekdays with medical complaints were included if oriented in time and place, able to sit on a chair and have a 30s-CST–score ≤ 8. Baseline data were collected within the first 48 hours of admission and the 30s-CST again one month after admission. All risk factors are identified in the literature. The 30s-CST is used at community level, but has not been validated in ED, and a floor effect is expected at admission. In contrast DEMMI has been validated for acute elderly patients.
Based on n= 50 + 8x numbers of independent variables and 20 % loss the sample size calculation stated 156 patients. Predicators for rehabilitation need were analyzed in logistics regression models.
A loss of 39 patients means that 117 were included in the analysis. The baseline predictors for rehabilitation needs were: Female gender: (OR 1.6); using assistive device (OR 4.6); reduced ability to climb a stairway (OR 2.8); no physical activity beside daily basic activities (OR 2.5). A clinical prediction model based on these variables had an AUC of 0.80. DEMMI did not add any value to the model.
Discussion and Conclusion: This study shows that physical measurements are feasible in an emergency department and possible as a screening tool if it is closely associated to lower body strength. Before implementation a larger validation study is needed.
In brief the 30s-CTS seem able to identify acute admitted elderly in need for rehabilitation when combined with risk factors concerning habitual mobility.
Impact and implications: Focus on physical ability among the elderly is important both in terms of their independence, but also from an economic perspective.
Furthermore, the study reveals a reveals a tool, which can be used by physiotherapists in an emergency department.
Key words: elderly, rehabilitation, screenings tools
Funding acknowledgements: This study is supported by Research and Development Council, Hospital Lillebaelt
Original languageEnglish
Publication date11. Nov 2016
Number of pages1
Publication statusPublished - 11. Nov 2016

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