Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patie
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RESEARCH ARTICLE
Open Access
Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards Celine Van de Vyver1*, Anja Velghe1,2, Hilde Baeyens3, Jean-Pierre Baeyens3, Julien Dekoninck3,4, Nele Van Den Noortgate1,2 and Ruth Piers1,2
Abstract Background: Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods: In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results: On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions: Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward. Keywords: Usual gait speed, Palliative care, Advance care planning, One-year mortality
Background The last decades, the rapid ageing of our society brings an increasing prevalence of chronic diseases and frailty, thereby raising the number of patients with higher dependency at the end of life [1]. Of all the persons of 75 years and older, 30–60% have a geriatric risk profile. An * Correspondence: [email protected] 1 Department of Geriatric Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium Full list of author information is available at the end of the article
acute event occuring in this group of frail older patients often results in a need for hospitalization [2–4]. Most of these patients will be admitted on the acute geriatric ward, known for its focus on comprehensive geriatric assessment, early rehabilitation, early discharge planning, and person-centered care within a multidisciplinary team [5]. However, some of them will also be admitted on non-geriatric wards in which there is a more singledisease approach [5].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distr
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