Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC)

BMC Geriatrics

William D Molloy²  Nicola Cornally¹  Eileen O’Herlihy⁴  Una Cronin⁴  Gabrielle O’Keeffe⁵  Elizabeth O’Connell⁷  Elizabeth Healy³  Anton Svendrovski⁶  Yang Gao⁴  Rónán O’Caoimh² 

[1] School of Nursing, University College Cork, Cork, Ireland;COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland;Centre for Public Health Nursing, Ballincollig and Bishopstown, Co Cork, Ireland;Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland;Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland;UZIK Consulting Inc, 86 Gerrard St E, Unit 12D, Toronto, ON M5B 2J1, Canada;Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland

关键词: Abbreviated mental test score (AMTS);    Barthel index (BI);    Cognitive impairment;    Comorbidities;    Public health nurses (PHNs);    Risk instrument for screening in the community (RISC);    Clinical frailty scale (CFS);    Adverse outcomes;    Risk;    Frailty;    Screening;   

Others  :  1089963
DOI  :  10.1186/1471-2318-14-104

 received in 2014-08-05, accepted in 2014-09-10,  发布年份 2014

【 摘 要 】

Background

Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC).

Methods

A cohort of 803 community dwelling older adults were scored for frailty by their public health nurse (PHN) using the Clinical Frailty Scale (CFS) and for risk of three adverse outcomes: i) institutionalisation, ii) hospitalisation and iii) death, within the next year, from one (lowest) to five (highest) using the RISC. Prior to scoring, PHNs stated whether they regarded patients as frail.

Results

The median age of patients was 80 years (interquartile range 10), of whom 64% were female and 47.4% were living alone. The median Abbreviated Mental Test Score (AMTS) was 10 (0) and Barthel Index was 18/20 (6). PHNs regarded 42% of patients as frail, while the CFS categorized 54% (scoring ≥5) as frail. Dividing patients into low-risk (score one or two), medium-risk (score three) and high-risk (score four or five) using the RISC showed that 4.3% were considered high risk of institutionalization, 14.5% for hospitalization, and 2.7% for death, within one year of the assessment. There were significant differences in median CFS (4/9 versus 6/9 versus 6/9, p < 0.001), Barthel Index (18/20 versus 11/20 versus 14/20, p < 0.001) and mean AMTS scores (9.51 versus 7.57 versus 7.00, p < 0.001) between those considered low, medium and high risk of institutionalisation respectively. Differences were also statistically significant for hospitalisation and death. Age, gender and living alone were inconsistently associated with perceived risk. Frailty most closely correlated with functional impairment, r = −0.80, p < 0.001.

Conclusion

The majority of patients in this community sample were perceived to be low risk for adverse outcomes. Frailty, cognitive impairment and functional status were markers of perceived risk. Age, gender and social isolation were not and may not be useful indicators when triaging community dwellers. The RISC now requires validation against adverse outcomes.

【 授权许可】

   
2014 O’Caoimh et al.; licensee BioMed Central Ltd.

【 图 表 】

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