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Een screeningsinstrument om de geriatrische liaison in het ziekenhuis op te starten: de Voorlopige Indicator voor Plaatsing (VIP)

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Tijdschrift Gerontologie en Geriatrie

samenvatting

The proportional increase of the ageing population results in an ever growing percentage of elderly among hospitalised patients. Older patients have complex medical, social and psychological problems that could benefit from coordinated care or case management. Identification of high–risk older adults is mandatory to initiate a liaison geriatric management program. A simple screening tool is presented to identify older people at the time of admission who are at increased risk of adverse health outcomes. The instrument was validated during a period of 6 months when all (n=618) older adults (> 70 year) hospitalised in non–geriatric departments of a general hospital were screened. This “Variable Indicative of Placement risk” (VIP) shows a good sensitivity (81 %) and specificity (86 %) and has a high Negative Predictive Value (97 %). Furthermore, it shows a significant positive correlation with the length of stay (p < 0.001). The questionnaire turned out to be a very useful tool in the emergency department as well as in other wards because it probes premorbid frailty components with three simple questions. Due to its simplicity a nurse without geriatric training can complete it. Patients who are not at risk of an adverse outcome are easily recognised. A positive score indicates loss of functional independence and a risk of increased length of stay. Further geriatric assessment and intervention seem then appropriate.

Samenvatting

Met de vergrijzing wordt ook de gehospitaliseerde patiëntenpopulatie ouder en fragieler. Hierdoor zullen naast de zuiver medische en somatische problematiek ook psychosociale factoren steeds belangrijker worden. Om deze patiënten adequaat op te vangen is een meer globale en vooral tijdig ingestelde geriatrische aanpak nodig. Dit kan verwezenlijkt worden via een zorgprogramma Geriatrie. Om dit op te starten zijn er echter “triggers” nodig. Om die reden wordt een screeningsinstrument voorgesteld dat gemakkelijk toepasbaar is, ook door paramedici. Het instrument werd gevalideerd op alle (n=618) opgenomen ouderen (> 70 jaar) op de niet geriatrische afdelingen van een algemeen ziekenhuis gedurende 6 maanden. Deze “Voorlopige Indicator voor Plaatsing” (VIP) toont een goede sensitiviteit (81 %) en specificiteit (86 %) en een hoge negatief predictieve waarde (97 %) voor een verhoogde zorgbehoefte die de oorzaak kan zijn van ontslagproblemen. Hij vertoont daarnaast een positieve correlatie met een verlengde ligduur (p < 0.001). Het instrument kan gebruikt worden zowel op de spoedafdeling als op de ziekenhuisafdelingen omdat het zich via anamnese richt naar premorbide frailtyfactoren. Door zijn eenvoud kan het gescoord worden door een verpleegkundige zonder specifieke geriatrische opleiding. Hierdoor worden patiënten met weinig risico gemakkelijk herkend. Een positieve score doet ontslagproblemen en een verlengde ligduur vermoeden. Opstarten van de geriatrische liaisonfunctie lijkt dan aangewezen.

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  1. www.bsl.nl/shop/tijdschrift-voor-gerontologie-en-geriatrie-0167-9228.html

    M. F. J. Vandewoude

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  1. M. F. J. Vandewoude
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  2. C. A. M. Geerts
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  3. A. H. M. d’Hooghe
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  4. K. M. J. Paridaens
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Correspondence to M. F. J. Vandewoude.

Additional information

Diensthoofd Universitair Centrum Geriatrie Antwerpen

Geriatrisch verpleegkundige, Universitair Centrum Geriatrie Antwerpen

Universitair Centrum Geriatrie Antwerpen

Universitair Centrum Geriatrie Antwerpen

Correspondentie: Prof Dr M.Vandewoude, UCG, site Elisabeth ZNA, Leopoldstraat 26, 2000 Antwerpen, België Telefoon: (32)-3-234 41 11

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Vandewoude, M.F.J., Geerts, C.A.M., d’Hooghe, A.H.M. et al. Een screeningsinstrument om de geriatrische liaison in het ziekenhuis op te starten: de Voorlopige Indicator voor Plaatsing (VIP). GEEG 37, 260–266 (2006). https://doi.org/10.1007/BF03074806

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