Functional assessment of older patients in the emergency department: comparison between standard instruments, medical records and physicians' perceptions.

Full Abstract

BACKGROUND:
We evaluated the accuracy of physician recognition of functional status impairment in older emergency departments (ED) patients. In particular, we evaluated the accuracy of medical records (a comparison of the information in the medical record with the functional status based on proxy interviews), and the accuracy of physician knowledge (a comparison of the information obtained from the responsible physician with the functional status based on proxy interviews).

METHODS:
Cross-sectional study on 101 frail older patients selected at random from among those attending ED, their ED physicians, and respondents. The study was conducted at ED in four general university teaching hospitals in a city, from July through November 2003. Functional data shown on patients' medical records were compared against functional data obtained from respondents (family members), using Kendall's Tau-b statistic. In addition patients' Katz Indices (which assesses six basic activities of daily living--basic ADL) based on interviews with ED physicians were compared against those obtained from respondents, using the coefficient of concordance weighted kappa (kappa). Each patient and his respondent were paired with a single physician.

RESULTS:
The correlation between information on dependence for basic ADL obtained from medical records and that furnished by respondents, was 0.41 (95% CI 0.27-0.55). Concordance between the respective Katz Indices obtained from physicians and respondents was 0.47 (95% CI 0.38-0.57).

CONCLUSION:
Older subjects' functional status is not properly assessed by emergency department physicians.

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Author information

Author/s: Rodríguez-Molinero, Alejandro (A); López-Diéguez, María (M); Tabuenca, Ana I (AI); de la Cruz, Juan J (JJ); Banegas, José R (JR);

Affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain. rodriguez.molinero(-atsign-)gmail.com

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: BMC geriatrics (BMC Geriatr), published in England. (Language: eng)

Reference: 2006-; vol 6 (issue ) : pp 13

Dates: Created 2006/09/18; Completed 2006/10/17; Revised 2008/11/20;

PMID: 16952319, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Activities of Daily Living
Aged, 80 and over
Cross-Sectional Studies
Emergency Service, Hospital - standards
Female
Frail Elderly

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