SCREENING FOR GERIATRIC PROBLEMS IN THE EMERGENCY DEPARTMENT - RELIABILITY AND VALIDITY

Objective: To determine the test-retest reliability and concurrent cri terion validity of a self-report ED screening questionnaire for advers e outcomes in elders. Methods: A cohort of 1,885 patients aged greater than or equal to 65 years were recruited from the EDs of 4 Montreal h ospitals. Patients were excluded if they could not be interviewed beca use of their clinical status or cognitive impairment and no informant was available. The screening questionnaire, administered in the ED, co ntained 27 items on social, physical, and mental risk factors, medical history, and use of hospital services, medications, and alcohol. A ra ndom sample of 404 patients were invited to participate in a clinical assessment 1-3 weeks after the ED visit, that included re-administrati on of the screening questionnaire, and standardized instruments to ass ess disability, social resources, depression, alcohol use and abuse, a nd current medications. Results: Study data were collected from 221 pa tients (54.7%), of whom 193 were included in the test-retest reliabili ty analyses and 213 in the analyses of concurrent validity. The concor dance correlation coefficient for test-retest reliability of the risk factor score was 0.78 (95% confidence interval: 0.71, 0.83; n = 193). Several screening questions showed moderately good agreement with the appropriate criterion standard, particularly those on visual and heari ng impairment, depression, and use of medications. The best subset of 9 screening questions explained approximately half of the variance in the total disability score. Conclusions: The screening questionnaire s core has good test-retest reliability, but individual screening questi ons have, at best, modest concurrent validity. The final set of screen ing questions should be selected based on their predictive validity.