A Brief Risk Stratification Tool to Predict Functional Decline in Older Adults Discharged from Emergency Departments

OBJECTIVES: To determine the effectiveness of the six‐item Triage Risk Screening Tool (TRST) to assess baseline functional status and predict subsequent functional decline in older community‐dwelling adults discharged home from the emergency department (ED). DESIGN: Secondary data analysis of a randomized, controlled trial. SETTING: EDs of two urban academic hospitals. PARTICIPANTS: Six hundred fifty community‐dwelling adults aged 65 and older presenting to the ED and discharged home. Patients were categorized a priori as “high risk” if they had cognitive impairment or two or more risk factors on the TRST. MEASUREMENTS: Functional status: summed activity of daily living (ADL) and instrumental activity of daily living (IADL) scores at baseline, 30 days, and 120 days. Self‐perceived physical health: standardized physical health component of the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Functional decline: loss of one or more ADLs and one or more IADLs from ED baseline at 30 and 120 days. Decline in self‐perceived physical health: follow‐up SF‐36 standardized physical health component scores four or more points lower than baseline. RESULTS: TRST scores correlated with baseline ADL impairments, IADL impairments, and self‐perceived physical health at all endpoints (P