Impaired chair-to-bed transfer ability leads to longer hospital stays among elderly patients

BACKGROUND: The study objectives were to identify the main predictive factors for long hospital stays and to propose new and improved methods of risk assessment. METHODS: This prospective cohort study was conducted in the clinics and surgical wards of a tertiary hospital and involved 523 elderly patients over 60 years of age. Demographic, clinical, functional, and cognitive characteristics assessed between 48 and 72 h after admission were analyzed to investigate correlations with lengths of stay greater than 10 days. Univariate and multivariate analyses were performed, and in the final model, long-term probability scores were estimated for each variable. RESULTS: Of the 523 patients studied, 33 (6.3%) remained hospitalized for more than 10 days. Multiple regression analysis revealed that both the presence of diabetes and the inability to perform chair-to-bed transfers (Barthel Index) remained significant risk predictors. Diabetes doubled the risk of prolonged hospital stays, while a chair-to-bed transfer score of 0 or 5 led to an eight-fold increase in risk. CONCLUSIONS: In this study, we propose an easy method that can be used, after external validation, to screen for long-term risk (using diabetes and bed/chair transfer) as a first step in identifying hospitalized elderly patients who will require comprehensive assessment to guide prevention plans and rehabilitation programs

Dementia Rating Scale psychometric study and its applicability in long term care institutions in Brazil

Objective: To evaluate the diagnostic sensitivity, specificity, andagreement of the Dementia Rating Scale with clinical diagnosis ofcognitive impairment and to compare its psychometric measureswith those from Mini Mental State Examination. Methods: Eighty-sixelders from a long-term care institution were invited to participatein a study, and fifty-eight agreed to participate. The global healthassessment protocol applied to these elders contained Mini MentalState Examination and Dementia Rating Scale. Clinical diagnose ofcognitive impairment was performed by experts using the DSM-IVcriteria. Dementia Rating Scale score was correlated to the MiniMental State Examination. Sensitivity and specificity of the DementiaRating Scale and the Mini Mental State Examination were calculated.Results: Twenty-two (37.9%) elders had cognitive impairment (8.6%presented with mental cognitive impairment and 29.3% dementia).The Mini Mental State Examination and the Dementia Rating Scaleclassified 31% and 55.2% as presenting with cognitively impaired.Dementia Rating Scale and the Mini Mental State Examination scorespresented a strong correlation. Dementia Rating Scale had a highersensitivity than Mini Mental State Examination (86.4% versus 61.9%).Dementia Rating Scale presented lower diagnostic specificity thanMini Mental State Examination (63.9% versus 86.5%). ConsideringDementia Rating Scale and Mini Mental State Examination, thediagnostic agreement between them and the clinical diagnosiswas similar. Conclusions: Dementia Rating Scale showed a highsensitivity to detect cognitive impairment in this population, and itcould be a useful tool in these settings