Optimizing geriatric patient care via screening for risk of functional decline
Due to demographic changes, the German health system is confronted with an increasing number of older, multimorbid (geriatric) patients. Even though there is increasing interest in understanding the role of geriatric problems for poor health outcomes, there is little information on how optimized geriatric risk screening can improve health outcomes of geriatric patients. In a first publication, we demonstrated that abnormal Identification of Seniors At Risk screening and Comprehensive Geriatric Assessment (including impairment of activities of daily living, mobility, cognition and emotion) results were associated with longer hospital stay, more hours of nursing and physiotherapy, higher number of falls and a lower percentage of regularly terminated treatments in older patients from internal medicine departments. However, the contents of geriatric risk screening and assessment are still a matter of debate. In a second publication, we identified the need to screen for symptoms of sleep disorders in a geriatric patient sample exhibiting mild mental and more advanced physical disabilities. Of note, more than 80% demonstrated some degree of sleep disordered breathing, defined by apnea-hypopnea index ≥5/h. However, self-report questionnaires of sleep disorders symptoms were not associated with apnea-hypopnea index, indicating that valid screening questionnaires of sleep disorders are lacking for geriatric patients. Since the Epworth Sleepiness Scale represents the most widely used self-report questionnaire to assess excessive daytime sleepiness, a major symptom of various sleep disorders, we adapted the ESS, which was developed and validated in community-dwelling adults, to better meet the needs of geriatric patients in a third publication. In an expert survey followed by a geriatric patient pilot study, we identified invalid items and replaced them by items better suited to assess daytime sleepiness in geriatric patients often exhibiting physical and mental disabilities. ESS item 3 “sitting inactively in a public place” and item 8 ”in a car while stopped” were identified as not adequate to assess daytime sleepiness in older multimorbid persons in the expert survey. These items also had the highest numbers of missing responses (37% and 69%, respectively). We replaced these items by items with a similar capacity to facilitate sleep but less missing responses in the patient pilot study. In the final version of this alternative ESS (ESS-ALT) to assess daytime sleepiness in geriatric persons, who often suffer from physical or mental disabilities, “sitting inactively in a public place” thus was replaced by “sitting in a waiting room” and “in a car while stopped” by “sitting and eating a meal”. The ESS-ALT had fewer missing responses (23% vs. 73%) and higher internal consistency (Cronbach’s α = 0.64 vs. 0.23) than the original ESS in our sample while keeping its original somnificity structure. Conclusively, my research project provides evidence of the need for geriatric risk screening and assessment, which should also include symptoms of sleep disorders, to decrease the risk of adverse health outcomes and functional decline in geriatric patients.