The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units

Abstract

Background: tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them.Objective: to evaluate whether the Identification of Seniors At Risk (ISAR) predicts the clinical outcomes and health and social services costs of older people discharged from acute medical units.Design: an observational cohort study using receiver–operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days (where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living (decrease of 2 or more points on the Barthel ADL Index), reduced mental well-being (increase of 2 or more points on the 12-point General Health Questionnaire) or reduced quality of life (reduction in the EuroQol-5D) and high health and social services costs over 90 days estimated from routine electronic service records.Setting: two acute medical units in the East Midlands, UK.Participants: a total of 667 patients aged ≥70 discharged from acute medical units.Results: an adverse outcome at 90 days was observed in 76% of participants. The ISAR was poor at predicting adverse outcomes (AUC: 0.60, 95% CI: 0.54–0.65) and fair for health and social care costs (AUC: 0.70, 95% CI: 0.59–0.81).Conclusions: adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making.

Baseline Characteristics and Outcomes of Older Adults Seeking Care in Ambulatory Urgent Care Clinics

“…In addition, these individuals should have early follow‐up with their PCP after an UCC visit. Similar workflows have been implemented in EDs,with encouraging results …”

Frailty Assessment in Acute Care

“…Studies exploring the predictive power of frailty scales for outcomes relevant to the UK acute medical care setting (Table 32) include prospective observational cohort studies (37,38,43) and secondary analysis of routinely collected large datasets, both clinical(178) and administrative (130,150). Our model performs uniformly across the clinical outcomes and is comparable in predictive power to frailty scores in the same setting.…”

“…Reliable recognition of frailty is a research priority for acute hospital care (38,48,53,162,173,201,243). It is essential to inform routine clinical decision making and plan appropriate care.…”

Principles for discharging patients from acute care: a scoping review of policy

“…Moreover, with our ageing population, patient complexity; policies are increasing and the guidance for this is extensive (British Geriatrics Society: The Silver Book, 2012, Edmans et al, 2013, RCP, Toolkit 3, 2012, Department of Health (DH), 2007, 2013, Age Concern, 2015. This creates the myriad of patient discharge policies developed for in-patient and rehabilitation wards, (DH, 2003, DH, 2004, DH, 2010.…”

“…Nonetheless, the problem with any risk assessment in a highly pressurised acute environment, such as AMU, is deciding what to include in the assessment, when and where is best to undertake this (Edmans, 2011, Edmans et al, 2013, Davis et al, 2005.…”