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Critical Care |

Functional Status After Critical Illness: Agreement Between Patient and Proxy Assessments

Amy Ahasic, MD; Terrence Murphy, PhD; Katy Araujo, MPH; Margaret Pisani, MD
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Yale University School of Medicine, New Haven, CT


Chest. 2013;144(4_MeetingAbstracts):393A. doi:10.1378/chest.1693988
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Abstract

SESSION TITLE: Non Pulmonary Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Studies of older adults in the ICU are often hampered by inability to assess patients’ baseline functional status prior to critical illness. Some components of functional status overlap with components of frailty, a marker of patient vulnerability. A reliable proxy instrument would allow assessment of baseline functional status and frailty in critically ill older persons preceding ICU admission. In order to determine validity of proxy assessments, we evaluated agreement between patient and proxy responses using instruments of functional status.

METHODS: Patients in this cohort were ≥60 years old. We examined responses from 179 paired patient-proxy interviews that included instruments for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). Interviews were conducted one month after ICU admission. Proxies were screened to determine the best available respondent. Kappa statistics were used to assess agreement.

RESULTS: Overall, there was good agreement between patients and proxies on assessment of BADLs, the strongest being bathing (κ=0.82; 95%CI 0.74, 0.91). There was also substantial agreement for dressing (κ=0.73; 95%CI 0.62, 0.84), toileting (κ=0.76; 95%CI 0.65, 0.87), transferring from bed to chair (κ=0.76; 95%CI 0.66, 0.87), walking across a small room (κ=0.79; 95%CI 0.69, 0.89), and eating (κ=0.62; 95%CI 0.46, 0.78). Agreement between patients and proxies for IADLs was more heterogeneous. Getting to places beyond walking distance showed excellent agreement (κ=0.86; 95%CI 0.75, 0.97). Agreement was substantial for grocery shopping (κ=0.68; 95%CI 0.49, 0.87), housework (κ=0.68; 95%CI 0.47, 0.90) and managing money (κ=0.69; 95%CI 0.55, 0.82). Using the telephone and preparing meals showed poor agreement. There was substantial negative correlation for self-administering medications (κ=-0.66; 95%CI -0.81, -0.52).

CONCLUSIONS: Well-chosen proxies are reliable for assessing the most easily observed components of functional status among older adults who survive to one month post-ICU discharge.

CLINICAL IMPLICATIONS: Ability to use proxy respondents to assess components of functional status and frailty at ICU admission may inform prognosis post-ICU. Further research will assess whether the current analysis can be extrapolated to the time of ICU admission.

DISCLOSURE: The following authors have nothing to disclose: Amy Ahasic, Terrence Murphy, Katy Araujo, Margaret Pisani

No Product/Research Disclosure Information


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