Risk Of Nursing Adverse Events In Hospitalized Elderly Medical Patients Based On Frailty Assessment

Objectives:To clarify the relationship between the occurrence of frailty and the risk of nursing adverse events in elderly inpatients in internal medicine wards,and to explore the factors involved in the risk score of nursing adverse events in frailty patients.Methods:A cross-sectional survey was conducted among inpatients aged≥60 years in the internal medicine wards of a tertiary hospital in Shandong province from November 2020 to June 2021.During hospitalization,the AGILE score was used to evaluate frailty of patients,grip strength of patients were measured,and the pressure injury risk assessment scale(Braden scale),VTE risk assessment scale(Caprini risk assessment),falls risk assessment scale(Morse Fall Risk Assessment Scale)were used to assess the risk of nursing adverse event.The basic information,treatments and laboratory examination information of patients were recorded from the hospital medical record management system.SPSS 26.0 statistical software was used for data analyses.One-way ANOVA test+LSD-t test and nonparametric test was used for comparison between groups for according data types.ANCOVA analysis was performed with age,weight,white blood cell count,albumin level,hemoglobin content and serum calcium concentration controlled as covariates.Finally,the risk factors of pressure injury risk score,falls risk score and VTE risk score were analyzed by linear regression.LASSO regression was used to screen risk factors for nursing adverse events.Based on the selected risk factors,a nomogram was constructed,and the model was evaluated by the clinical decision curve analysis(DCA).Results:1.A total of 150 elderly internal medicine inpatients completed the baseline assessment,and 138 patients(67 males and 71 females,respectively)were enrolled.According to the AGILE score,the patients were separated into non-frailty,pre-frailty group,mild frailty group and moderate-severe frailty group.There were 8 cases in the non-frailty group(5.33%),33 cases in the pre-frailty group(22.00%),and 70 cases in the mild frailty group(46.67%),including 34 male patients.There were 39 cases in moderate-severe frailty group,covering 26.00%,including 17 male patients.There was no significant difference in the diagnosis distribution of major diseases among subjects with different degrees of frailty.2.Compared with the pre-frailty group,the leukocyte and neutrophil counts in the moderate-severe frailty group increased significantly(P<0.05),and the albumin content in the moderate-severe frailty group was significantly lower than that in the pre-frailty group and the mild frailty group(P<0.05).3.Compared with the pre-frailty group and the mild frailty group,the pressure injury risk score of the elderly patients in the moderate-severe frailty group was lower(P<0.05);Compared with the pre-frailty group,the moderate-severe frailty group had significantly higher risk scores and risk grades of VTE(P<0.05).Compared with the pre-frailty group and mild frailty patients,the grip strength of patients in the moderate-severe frailty group decreased significantly(P<0.05).4.Compared with the pre-frailty group and the mild frailty group,the proportions of potassium supplementation and sodium supplementation in the moderate-severe frailty group were significantly higher(P<0.05).Compared with the mild frailty group,the proportion of red blood cell transfusion in the moderate-severe frailty group was significantly higher(P<0.05).At discharge,there was no significant difference in blood examination results among the three groups.5.After controlling for age and weight,the risk of pressure injury,falls and VTE increased with the deterioration of frailty in the elderly patients(P<0.05);After controlling for age,body weight,leukocyte count,albumin level,hemoglobin level and serum calcium concentration,the pressure injury,falls and VTE risk scores of patients increased significantly with different frailty degrees(P<0.05).6.Potassium supplementation and albumin supplementation were beneficial influencing factors for pressure injury risk score,and D-dimer content and leukocyte count were risk factors for pressure injury risk score(P<0.05);Increased AGILE scores,increased creatinine levels,and low potassium and protein levels were the risk factors of falls(P<0.05);Increased AGILE scores,plasma transfusion and magnesium supplementation were the risk factors of VTE(P<0.05).7.LASSO regression screening showed that increased AGILE score,potassium supplementation,albumin infusion,and elevated alanine aminotransferase were predictive factors for increased risk for pressure injury(P<0.05);Albumin infusion was a predictive factor for increased risk of falls(P<0.001);Increased AGILE score,aging,serum creatinine level,and potassium supplementation were predictive factors for the increased risk of VTE(all P<0.05).8.Construction a nomogram of risk prediction model for VTE occurrence.The discrimination tested by AUC is 0.830,the accuracy of the prediction model is 0.775,and the Hosmer Lemeshow test is x2=216.71,P=0.857,which has good clinical usefulness estimated by DCA during internal validation.Construction a nomogram of risk prediction model for falls.The discrimination tested by AUC is 0.667,the accuracy of the prediction model is 0.855,and the Hosmer Lemeshow test is χ2=136,P=0.406,which has good clinical usefulness estimated by DCA during internal validation.Conclusion:1.With the aggravation of frailty,the risk of pressure injury,falls and VTE increased.2.The increase of AGILE score is an independent risk factor for the increase of risk score of falls and VTE.3.Increased AGILE scores is a predictive factor for the increased risk of pressure injury and VTE.4.The predictive model of nomograms based on AGILE score have good discrimination,calibration,and clinical usefulness.