BACKGROUND The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. METHODS Two hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. RESULTS The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β = - 0.19, 95% confidence interval (CI) = - 0.66;-0.13), number of admission diagnoses (β = 0.28, 95% CI = 0.16;0.41), ADL impairment (B = 6.66, 95% CI = 3.312;10.01), and signs of depression (B = 6.69, 95% CI = 1.43;11.94) independently predicted length of hospital stay. ADL impairment (B = 1.14, 95%CI = 0.67;1.61), cognition impairment (B = 0.57, 95% CI = 0.07;1.07) and ISAR score (β =0.26, 95% CI = 0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR) = 1.06, 95% CI = 1.04;1.08), ADL impairment (RR = 3.54, 95% CI = 2.29;5.47), cognition impairment (RR = 1.77, 95% CI = 1.20;2.62) and signs of depression (RR = 1.99, 95% CI = 1.39;2.85) predicted receiving physiotherapy. CONCLUSION Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

中文翻译：

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临床和功能患者的特征预测了处于功能下降风险的老年患者的医疗需求。

背景技术越来越多的多病态住院患者对医疗服务具有影响。越来越需要确定预测医院环境中老年患者需求的因素。我们的目的是评估临床和功能患者特征在预测老年住院患者医疗需求中的用途。方法前瞻性纳入2015年7月至2017年2月在埃森大学医院内科连续收治的24例住院患者（男57.4％），年龄78.4±6.4岁。入院时先对患者进行评估，方法是“老年人风险鉴定”（ISAR）筛查，然后进行综合老年医学评估（CGA）。CGA包括标准化工具，用于评估入院时的日常生活活动（ADL），认知，活动能力和抑郁症状。在多变量回归中，我们评估了临床患者特征，ISAR评分和CGA结果与住院时间，护理时间和接受理疗次数之间的关联，以作为医疗需求的指标。我们确定了与更高医疗需求相关的临床特征和危险因素。结果242例患者在医院中度[Q（Q1; Q3）]：9.0（4.0; 16.0）天，每天需要2.0（1.5; 2.7）小时的护理，而34.3％的患者接受了理疗。在多变量回归分析中，包括临床患者特征，ISAR和CGA域，因素年龄（β=-0.19，95％置信区间（CI）=-0.66; -0.13），入院诊断的次数（β= 0.28，95％CI = 0.16; 0.41），ADL障碍（B = 6.66，95％CI = 3.312; 10.01），抑郁症状（B = 6.69，95％CI = 1.43; 11.94 ）独立预测住院时间。独立预测护理的ADL障碍（B = 1.14，95％CI = 0.67; 1.61），认知障碍（B = 0.57，95％CI = 0.07; 1.07）和ISAR评分（β= 0.26，95％CI = 0.01; 0.28）小时。入院诊断的数量（风险比（RR）= 1.06，95％CI = 1.04; 1.08），ADL障碍（RR = 3.54，95％CI = 2.29; 5.47），认知障碍（RR = 1.77，95％CI = 1.20; 2.62）和预计会接受理疗的抑郁症状（RR = 1.99，95％CI = 1.39; 2.85）。结论在有功能下降风险的老年住院患者中，合并症数量，ADL降低，