The decline in Activities of Daily Living at Discharge (DADLD) index: stratifying patients at lower and higher risk

BACKGROUND: Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. OBJECTIVE: To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. DESIGN: Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD+/- 7.1) and a validation cohort (n=153; mean age 81.5 years; SD+/- 6.1). PATIENTS AND SETTING: General medical patients aged >/= 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. MEASUREMENT AND MAIN RESULTS: The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). CONCLUSIONS: The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.

https://link.springer.com/content/pdf/10.1007/s12603-012-0092-2.pdf