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How to Try This: The Hospital Admission Risk Profile

AJN, American Journal of Nursing: August 2008 - Volume 108 - Issue 8 - p 72
doi: 10.1097/01.NAJ.0000330269.73550.6c
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GENERAL PURPOSE: To describe for registered professional nurses how to use and interpret the Hospital Admission Risk Profile (HARP) to screen hospitalized older patients for their risk of functional decline.

LEARNING OBJECTIVES: After reading this article and taking the test on the next page, you will be able to

  • discuss the need for using a hospital risk assessment tool.
  • outline the appropriate use of the HARP.
  • summarize the development and outcomes of the HARP.


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1. According to a study by Sager and colleagues, what percentage of hospitalized older adults experienced functional decline in activities of daily living (ADLs)?

a. 31%

b. 40%

c. 49%

d. 58%

2. In the same study, what percentage of the population had developed new functional declines in ADLs or independent activities of daily living (IADLs) at 3 months after discharge?

a. 31%

b. 40%

c. 49%

d. 58%

3. Which of the following is an age-related change that contributes to deconditioning in older adults?

a. decreased total body fat

b. increased stroke volume

c. decreased muscle mass

d. increased cardiac output

4. A study by Callen and colleagues found that 118 ambulatory hospitalized older patients had a median hallway-ambulation time of

a. 5.5 minutes.

b. 10.5 minutes.

c. 15.5 minutes.

d. 20.5 minutes.

5. Which of the following was identified by Sager and colleagues as 1 of 3 variables that predict functional decline?

a. multiple chronic illnesses

b. altered level of consciousness

c. reduced IADL function 4 weeks before admission

d. diminished cognitive function on admission

6. The Hospital Admission Risk Profile (HARP) uses IADL assessment because

a. loss of IADLs usually precedes loss of ADLs.

b. IADLs can be evaluated more directly than ADLs.

c. IADLs are more essential for independent living.

d. ADLs have less relevance for hospital risk.

7. It's recommended that the HARP be administered

a. on admission only.

b. on discharge only.

c. once per week during hospitalization.

d. on admission and again on discharge.

8. The largest group of questions on the HARP addresses

a. recall.

b. memory.

c. cognition.

d. attention.

9. In the author's experience, it takes approximately how many minutes to complete the HARP?

a. 5 to 10

b. 10 to 15

c. 15 to 20

d. 20 to 25

10. One of the 7 IADLs that the HARP assesses is

a. gardening.

b. walking on a treadmill.

c. using transportation.

d. remaining continent.

11. A score of 4 on the HARP indicates what level of risk?

a. no risk

b. low risk

c. intermediate risk

d. high risk

12. The HARP doesn't necessarily identify

a. patients most likely to benefit from geriatric interventions.

b. patients at various risk levels for functional decline.

c. data needed for informed decision making about goals of care.

d. the results of a structured cognitive assessment.

13. The purpose of the development phase of the HARP was to

a. estimate the effect of age-related body-system changes on cognitive decline.

b. develop a tool for evaluating the hospital environment for potential adverse effects.

c. identify risk factors predictive of ADL loss during hospitalization for a medical illness.

d. predict variability in older adults' inability to perform ADLs after hospitalization.

14. A validation study found that rates of decline in ADL performance at discharge were similar across groups in both cohorts. The low-risk groups had decline rates of

a. 10% and 12%.

b. 17% and 19%.

c. 24% and 26%.

d. 31% and 33%.

15. In the same study, at discharge, the high-risk groups had decline rates of

a. 55% and 56%.

b. 62% and 62%.

c. 69% and 70%.

d. 76% and 77%.

16. Which of the following questions can be used in assessing cognition?

a. Are you able to drive your car?

b. What are today's date and the day of the week?

c. Do you have trouble using the telephone?

d. Do you need help taking your medicine?

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