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

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    Authors
    O Caoimh, Rónán
    Gao, Yang
    Svendrovski, Anton
    Healy, Elizabeth
    O Connell, Elizabeth
    O Keeffe, Gabrielle
    Cronin, Una
    O Herlihy, Eileen
    Cornally, Nicola
    Molloy, William D
    Issue Date
    2014-09-19
    Keywords
    OLDER PEOPLE
    SCREENING
    COMMUNITY CARE
    
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    Citation
    Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC). 2014, 14 (1):104 BMC Geriatr
    Publisher
    BMC geriatrics
    Journal
    BMC geriatrics
    URI
    http://hdl.handle.net/10147/331949
    DOI
    10.1186/1471-2318-14-104
    PubMed ID
    25238874
    Abstract
    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).
    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.
    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.
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1471-2318
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2318-14-104
    Scopus Count
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