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Clarnette RM, Kostov I, Ryan JP, Svendrovski A, Molloy DW, O'Caoimh R. Predicting Outcomes in Frail Older Community-Dwellers in Western Australia: Results from the Community Assessment of Risk Screening and Treatment Strategies (CARTS) Programme. Healthcare (Basel) 2024; 12:1339. [PMID: 38998873 PMCID: PMC11241488 DOI: 10.3390/healthcare12131339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Understanding risk factors for frailty, functional decline and incidence of adverse healthcare outcomes amongst community-dwelling older adults is important to plan population-level health and social care services. We examined variables associated with one-year risk of institutionalisation, hospitalisation and death among patients assessed in their own home by a community-based Aged Care Assessment Team (ACAT) in Western Australia. Frailty and risk were measured using the Clinical Frailty Scale (CFS) and Risk Instrument for Screening in the Community (RISC), respectively. Predictive accuracy was measured from the area under the curve (AUC). Data from 417 patients, median 82 ± 10 years, were included. At 12-month follow-up, 22.5% (n = 94) were institutionalised, 44.6% (n = 186) were hospitalised at least once and 9.8% (n = 41) had died. Frailty was common, median CFS score 6/9 ± 1, and significantly associated with institutionalisation (p = 0.001), hospitalisation (p = 0.007) and death (p < 0.001). Impaired activities of daily living (ADL) measured on the RISC had moderate correlation with admission to long-term care (r = 0.51) and significantly predicted institutionalisation (p < 0.001) and death (p = 0.01). The RISC had the highest accuracy for institutionalisation (AUC 0.76). The CFS and RISC had fair to good accuracy for mortality (AUC of 0.69 and 0.74, respectively), but neither accurately predicted hospitalisation. Home assessment of community-dwelling older patients by an ACAT in Western Australia revealed high levels of frailty, ADL impairment and incident adverse outcomes, suggesting that anticipatory care planning is imperative for these patients.
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Affiliation(s)
- Roger M Clarnette
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Ivan Kostov
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Jill P Ryan
- Department of Nursing, Fiona Stanley Fremantle Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Anton Svendrovski
- UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON M5B 2J1, Canada
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Douglas Road, T12 XH60 Cork, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Douglas Road, T12 XH60 Cork, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
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Li S, Fan W, Zhu B, Ma C, Tan X, Gu Y. Frailty Risk Prediction Model among Older Adults: A Chinese Nation-Wide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148410. [PMID: 35886260 PMCID: PMC9322778 DOI: 10.3390/ijerph19148410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Numerous studies have been performed on frailty, but rarely do studies explore the integrated impact of socio-demographic, behavioural and social support factors on frailty. This study aims to establish a comprehensive frailty risk prediction model including multiple risk factors. METHODS The 2018 wave of the Chinese Longevity and Health Longitudinal Survey was used. Univariate and multivariate logistic regressions were performed to identify the relationship between frailty and multiple risk factors and establish the frailty risk prediction model. A nomogram was utilized to illustrate the prediction model. The area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test and calibration curve were used to appraise the prediction model. RESULTS Variables from socio-demographic, social support and behavioural dimensions were included in the final frailty risk prediction model. Risk factors include older age, working as professionals and technicians before 60 years old, poor economic condition and poor oral hygiene. Protective factors include eating rice as a staple food, regular exercise, having a spouse as the first person to share thoughts with, doing physical examination once a year and not needing a caregiver when ill. The AUC (0.881), Hosmer-Lemeshow test (p = 0.618), and calibration curve showed that the risk prediction model was valid. CONCLUSION Risk factors from socio-demographic, behavioural and social support dimensions had a comprehensive effect on frailty, further supporting that a comprehensive and individualized intervention is necessary to prevent frailty.
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Affiliation(s)
- Siying Li
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Wenye Fan
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Boya Zhu
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Chao Ma
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
- Correspondence: (X.T.); (Y.G.)
| | - Yaohua Gu
- School of Nursing, Wuhan University, Wuhan 430071, China
- Correspondence: (X.T.); (Y.G.)
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Wai JL, Yu DS. The relationship between sleep–wake disturbances and frailty among older adults: A systematic review. J Adv Nurs 2019; 76:96-108. [DOI: 10.1111/jan.14231] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Joyce Lok‐Tung Wai
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Doris Sau‐Fung Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
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Biopsychosocial factors associated with the frailty and pre-frailty among older adults. Geriatr Nurs 2019; 40:597-602. [PMID: 31255410 DOI: 10.1016/j.gerinurse.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/24/2022]
Abstract
Frailty is a multidimensional geriatric syndrome associated with specific biopsychosocial factors in each population. This was a cross-sectional observational study designed to determine the biopsychosocial factors associated with frailty and pre-frailty in older adults in a community in Salvador, Brazil. The stages of frailty were collected in 413 older adults: 34.9% frail, 54.5% pre-frail, 10.6% robust. In the multinomial regression model, age (p = .018), functionality for instrumental activities of daily living (p = .026), risk for falls (p = .006), family functionality (p = .031) and the physical domain of quality of life (p = .004) had an independent association with frailty. Risk for falls (p = .004), family functionality (p = .004) and the environment domain of quality of life (p = .037) were independently associated with pre-frailty. The findings provide support to interventions in a way that contributes to prevention or reversal of frailty.
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Zukeran MS, Ritti-Dias RM, Franco FGM, Cendoroglo MS, de Matos LDN, Lima Ribeiro SM. Nutritional Risk by Mini Nutritional Assessment (MNA), but Not Anthropometric Measurements, Has a Good Discriminatory Power for Identifying Frailty in Elderly People: Data from Brazilian Secondary Care Clinic. J Nutr Health Aging 2019; 23:217-220. [PMID: 30697634 DOI: 10.1007/s12603-018-1128-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate, in elderly individuals registered at a secondary outpatient clinic, the prevalence of frailty and pre-frailty and to identify the discriminatory power of anthropometric measurements and nutritional risk in identifying these conditions. DESIGN Cross-sectional study with data extracted from medical records. SETTING AND PARTICIPANTS Elderly patients (60+ years) from a geriatric outpatient clinic, located in the southeast area of São Paulo, Brazil. MEASUREMENTS Frailty was assessed using five criteria proposed by Fried et al (2001), with some modifications. Nutritional risk was identified using Mini Nutritional Assessment (MNA). Body weight and body height were measured and used to calculate the body mass index (BMI). The discriminatory power of these parameters for the identification of frailty was determined by Receiver Operating Characteristics (ROC) curves. RESULTS The final sample was composed of 254 patients, from which 31.1% were identified as frail and 53.5% as prefrail. The MNA indicated that 3.1% were malnourished and 35.4% were at risk of malnutrition. The BMI values 39.4% as overweight/obese and 19.9% as undernourished. As just the MNA revealed differences for frailty classification, only this parameter was investigated by ROC curve. The discriminatory power of the MNA for frailty presented a best cut-off point of ≤23.0 and the AUC was 0.812 (sensitivity=55.7; specificity=94.9), with a youden index of 0.5057 (95%CI= 0.3146-0.5946). MNA did not present sufficient discriminatory power to detect pre-frailty. CONCLUSION The MNA was capable of indicating frailty, but not pre-frailty in this sample. BMI did not display significant predictive power for frailty or pre-frailty.
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Affiliation(s)
- M S Zukeran
- Mariana Staut Zukeran, Hospital Israelita Albert Einstein; Universidade de Sao Paulo, Brazil,
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Kelly S, O'Brien I, Smuts K, O'Sullivan M, Warters A. Prevalence of frailty among community dwelling older adults in receipt of low level home support: a cross-sectional analysis of the North Dublin Cohort. BMC Geriatr 2017; 17:121. [PMID: 28592236 PMCID: PMC5463412 DOI: 10.1186/s12877-017-0508-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty. METHODS A total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis. RESULTS The cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65-84 years. However, in the oldest age groups, namely 90-94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508. CONCLUSION A high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.
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Affiliation(s)
- Sara Kelly
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Irene O'Brien
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Karla Smuts
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland.,Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Maria O'Sullivan
- Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Austin Warters
- Health Service Executive Healthcare Facility, Ballymun, Dublin 9, Ireland.
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Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr 2016; 62:9-25. [DOI: 10.1016/j.archger.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/04/2023]
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O'Caoimh R, Gao Y, Svendrovski A, Healy E, O'Connell E, O'Keeffe G, Cronin U, Igras E, O'Herlihy E, Fitzgerald C, Weathers E, Leahy-Warren P, Cornally N, Molloy DW. The Risk Instrument for Screening in the Community (RISC): a new instrument for predicting risk of adverse outcomes in community dwelling older adults. BMC Geriatr 2015. [PMID: 26224138 PMCID: PMC4520060 DOI: 10.1186/s12877-015-0095-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Predicting risk of adverse healthcare outcomes, among community dwelling older adults, is difficult. The Risk Instrument for Screening in the Community (RISC) is a short (2–5 min), global subjective assessment of risk created to identify patients’ 1-year risk of three outcomes:institutionalisation, hospitalisation and death. Methods We compared the accuracy and predictive ability of the RISC, scored by Public Health Nurses (PHN), to the Clinical Frailty Scale (CFS) in a prospective cohort study of community dwelling older adults (n = 803), in two Irish PHN sectors. The area under the curve (AUC), from receiver operating characteristic curves and binary logistic regression models, with odds ratios (OR), compared the discriminatory characteristics of the RISC and CFS. Results Follow-up data were available for 801 patients. The 1-year incidence of institutionalisation, hospitalisation and death were 10.2, 17.7 and 15.6 % respectively. Patients scored maximum-risk (RISC score 3,4 or 5/5) at baseline had a significantly greater rate of institutionalisation (31.3 and 7.1 %, p < 0.001), hospitalisation (25.4 and 13.2 %, p < 0.001) and death (33.5 and 10.8 %, p < 0.001), than those scored minimum-risk (score 1 or 2/5). The RISC had comparable accuracy for 1-year risk of institutionalisation (AUC of 0.70 versus 0.63), hospitalisation (AUC 0.61 versus 0.55), and death (AUC 0.70 versus 0.67), to the CFS. The RISC significantly added to the predictive accuracy of the regression model for institutionalisation (OR 1.43, p = 0.01), hospitalisation (OR 1.28, p = 0.01), and death (OR 1.58, p = 0.001). Conclusion Follow-up outcomes matched well with baseline risk. The RISC, a short global subjective assessment, demonstrated satisfactory validity compared with the CFS.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. .,COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland. .,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland.
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland.
| | - Anton Svendrovski
- UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON, M5B 2 J1, Canada.
| | - Elizabeth Healy
- Centre for Public Health Nursing, Ballincollig and Bishopstown, Co, Cork, Ireland.
| | - Elizabeth O'Connell
- Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland.
| | - Gabrielle O'Keeffe
- Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland.
| | - Una Cronin
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland.
| | - Estera Igras
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland.
| | - Eileen O'Herlihy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland.
| | - Carol Fitzgerald
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland.
| | - Elizabeth Weathers
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. .,School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | | | - Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. .,School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. .,COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland.
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Hanafin S, Roe S, O'Dowd M, Barry C. Supporting the use of evidence in community nursing: a national strategic approach. Br J Community Nurs 2014; 19:496-501. [PMID: 25284186 DOI: 10.12968/bjcn.2014.19.10.496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While there is an acceptance across all stakeholders that nursing practice should be informed by evidence, there is a substantial literature on the challenges this creates for nurses in the delivery of services. These challenges are accentuated for nurses in community settings, where accessible, up-to-date research evidence is more problematic because of the decentralised organisation and delivery of these services. Recognising this gap, and the consequent needs of its members, the Institute of Community Health Nursing (ICHN) in Ireland has commenced a national strategic development in this area. The purpose of the strategy is to actively support and facilitate public health and community nurses to provide services to individuals, families and communities that are based on the best available research evidence. This article provides a brief overview of the development and key components of the ICHN strategy.
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Affiliation(s)
- Sinéad Hanafin
- Visiting Research Fellow, School of Nursing and Midwifery, Trinity College Dublin
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O’Caoimh R, Gao Y, Svendrovski A, Healy E, O’Connell E, O’Keeffe G, Cronin U, O’Herlihy E, Cornally N, Molloy WD. Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC). BMC Geriatr 2014; 14:104. [PMID: 25238874 PMCID: PMC4177708 DOI: 10.1186/1471-2318-14-104] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Rónán O’Caoimh
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
- />COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
| | - Yang Gao
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
| | - Anton Svendrovski
- />UZIK Consulting Inc, 86 Gerrard St E, Unit 12D, Toronto, ON M5B 2J1 Canada
| | - Elizabeth Healy
- />Centre for Public Health Nursing, Ballincollig and Bishopstown, Co Cork, Ireland
| | - Elizabeth O’Connell
- />Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland
| | - Gabrielle O’Keeffe
- />Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
| | - Una Cronin
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
| | - Eileen O’Herlihy
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
| | - Nicola Cornally
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
- />School of Nursing, University College Cork, Cork, Ireland
| | - William D Molloy
- />Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland
- />COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
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