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Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study
BACKGROUND: frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10353758/ https://www.ncbi.nlm.nih.gov/pubmed/37463282 http://dx.doi.org/10.1093/ageing/afad116 |
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author | Leahy, Aoife Corey, Gillian Purtill, Helen O’Neill, Aoife Devlin, Collette Barry, Louise Cummins, Niamh Gabr, Ahmed Mohamed, Abdirahman Shanahan, Elaine Shchetkovsky, Denys Ryan, Damien O’Loughlin, Monica O'Connor, Margaret Galvin, Rose |
author_facet | Leahy, Aoife Corey, Gillian Purtill, Helen O’Neill, Aoife Devlin, Collette Barry, Louise Cummins, Niamh Gabr, Ahmed Mohamed, Abdirahman Shanahan, Elaine Shchetkovsky, Denys Ryan, Damien O’Loughlin, Monica O'Connor, Margaret Galvin, Rose |
author_sort | Leahy, Aoife |
collection | PubMed |
description | BACKGROUND: frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30 days and 6 months amongst older adults presenting to the Emergency Department (ED). METHODS: a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables. RESULTS: a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes. CONCLUSION: older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention. |
format | Online Article Text |
id | pubmed-10353758 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-103537582023-07-19 Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study Leahy, Aoife Corey, Gillian Purtill, Helen O’Neill, Aoife Devlin, Collette Barry, Louise Cummins, Niamh Gabr, Ahmed Mohamed, Abdirahman Shanahan, Elaine Shchetkovsky, Denys Ryan, Damien O’Loughlin, Monica O'Connor, Margaret Galvin, Rose Age Ageing Research Paper BACKGROUND: frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30 days and 6 months amongst older adults presenting to the Emergency Department (ED). METHODS: a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables. RESULTS: a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes. CONCLUSION: older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention. Oxford University Press 2023-07-15 /pmc/articles/PMC10353758/ /pubmed/37463282 http://dx.doi.org/10.1093/ageing/afad116 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Research Paper Leahy, Aoife Corey, Gillian Purtill, Helen O’Neill, Aoife Devlin, Collette Barry, Louise Cummins, Niamh Gabr, Ahmed Mohamed, Abdirahman Shanahan, Elaine Shchetkovsky, Denys Ryan, Damien O’Loughlin, Monica O'Connor, Margaret Galvin, Rose Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title | Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title_full | Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title_fullStr | Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title_full_unstemmed | Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title_short | Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study |
title_sort | screening instruments to predict adverse outcomes for undifferentiated older adults attending the emergency department: results of soaed prospective cohort study |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10353758/ https://www.ncbi.nlm.nih.gov/pubmed/37463282 http://dx.doi.org/10.1093/ageing/afad116 |
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