Detection of older people at increased risk of adverse health outcomes after an emergency visit: The ISAR screening tool

OBJECTIVES: To develop a self-report screening tool to identify older peopl e in the emergency department (ED) of a hospital at increased risk of adver se health outcomes, including: death, admission to a nursing home or long-t erm hospitalization, or a clinically significant decrease in functional sta tus. DESIGN: Prospective (6-month) follow-up study of a cohort of ED patients ag ed 65 and older. SETTING: The EDs of four acute-care hospitals in Montreal, Quebec, Canada. PARTICIPANTS: Community-dwelling patients aged 65 and older who came to the EDs during the weekday shift over a 3-month recruitment period. Patients w ere excluded if they could not be interviewed either because of their medic al condition or because of cognitive impairment and no other informant was available. MEASUREMENTS: Measures ascertained at the ED visit included: 27 self-report screening questions on social, physical, and mental risk factors; medical history; use of hospital services, medications, and alcohol; and the Older American Resources and Services (OARS) activities of daily living (ADL) sca le. At follow-up, the OARS scale was readministered by telephone, and other adverse health outcomes were ascertained. RESULTS: Among 1673 patients who completed the follow-up measures, 488 (29. 2%) had an adverse health outcome. Scale development and selection methods included logistic regression, receiver operating characteristic curves, and expert judgment. The proposed screening tool (ISAR) comprises six self-rep ort questions on functional dependence (premorbid and acute change), recent hospitalization, impaired memory and vision, and polymedication. The tool performed well in the total cohort aged 65 and older, and in sub-groups def ined by disposition (admitted or released from ED), language of questionnai re administration (French or English), information source (patient or other ), and other characteristics. CONCLUSIONS: The ISAR is a short self-report questionnaire that can quickly identify older patients in the ED at increased risk of several adverse hea lth outcomes and those with current disability.