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 people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long‐term hospitalization, or a clinically significant decrease in functional sta...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 1999-10, Vol.47 (10), p.1229-1237 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | McCusker, Jane Bellavance, Francois Cardin, Sylvie Trepanier, Sylvain Verdon, Josee Ardman, Orly |
| description | OBJECTIVES: To develop a self‐report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long‐term hospitalization, or a clinically significant decrease in functional status.
DESIGN: Prospective (6‐month) follow‐up study of a cohort of ED patients aged 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 were excluded if they could not be interviewed either because of their medical 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) scale. 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‐report 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 defined by disposition (admitted or released from ED), language of questionnaire 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 health outcomes and those with current disability. |
| doi_str_mv | 10.1111/j.1532-5415.1999.tb05204.x |
| format | Article |
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DESIGN: Prospective (6‐month) follow‐up study of a cohort of ED patients aged 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 were excluded if they could not be interviewed either because of their medical 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) scale. 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‐report 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 defined by disposition (admitted or released from ED), language of questionnaire 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 health outcomes and those with current disability.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.1999.tb05204.x</identifier><identifier>PMID: 10522957</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; Analysis. Health state ; Biological and medical sciences ; Chi-Square Distribution ; Clinical outcomes ; Cohort Studies ; Elderly people ; Emergency admission ; emergency department ; Emergency Service, Hospital ; Emergency services ; Epidemiology ; Female ; functional decline ; General aspects ; Geriatric Assessment ; Health risk assessment ; Hospitals ; Humans ; Logistic Models ; Male ; Medical sciences ; Older people ; Outcomes ; Prospective Studies ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Questionnaires ; Reproducibility of Results ; Risk assessment ; Risk Factors ; ROC Curve ; Screening ; Sensitivity and Specificity ; Surveys and Questionnaires ; validity</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 1999-10, Vol.47 (10), p.1229-1237</ispartof><rights>1999 The American Geriatrics Society</rights><rights>1999 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Oct 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5874-6f7e65a5279a0d67362725666fd97bd5d5456d5950add2bee832e7cf1d52f9333</citedby><cites>FETCH-LOGICAL-c5874-6f7e65a5279a0d67362725666fd97bd5d5456d5950add2bee832e7cf1d52f9333</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.1999.tb05204.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.1999.tb05204.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,30977,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1992326$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10522957$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McCusker, Jane</creatorcontrib><creatorcontrib>Bellavance, Francois</creatorcontrib><creatorcontrib>Cardin, Sylvie</creatorcontrib><creatorcontrib>Trepanier, Sylvain</creatorcontrib><creatorcontrib>Verdon, Josee</creatorcontrib><creatorcontrib>Ardman, Orly</creatorcontrib><title>Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES: To develop a self‐report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long‐term hospitalization, or a clinically significant decrease in functional status.
DESIGN: Prospective (6‐month) follow‐up study of a cohort of ED patients aged 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 were excluded if they could not be interviewed either because of their medical 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) scale. 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‐report 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 defined by disposition (admitted or released from ED), language of questionnaire 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 health outcomes and those with current disability.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis. Health state</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Elderly people</subject><subject>Emergency admission</subject><subject>emergency department</subject><subject>Emergency Service, Hospital</subject><subject>Emergency services</subject><subject>Epidemiology</subject><subject>Female</subject><subject>functional decline</subject><subject>General aspects</subject><subject>Geriatric Assessment</subject><subject>Health risk assessment</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Older people</subject><subject>Outcomes</subject><subject>Prospective Studies</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Questionnaires</subject><subject>Reproducibility of Results</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Screening</subject><subject>Sensitivity and Specificity</subject><subject>Surveys and Questionnaires</subject><subject>validity</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqVkV1v0zAUhiMEYmXwF5A1Ie4S_BHb8W5QV0ZXmChaC1xabnyypctHsRNo_z2OUg3EDcI3tuTnfX2sJ4rOCE5IWG-2CeGMxjwlPCFKqaTbYE5xmuwfRZOHq8fRBGNM40yQ9CR65v0WY0Jxlj2NTkjgqeJyEu3fQQd5V7YNagu0rCw49BnaXQXIdGjR5A6MB4tuSn8_EFP7A5wHdAWm6u7Qsu_ytgaPpkUXkqZBlzW4W2jyA_pa-rI7R-s7QIvV9AatQhc0ZXOL1m1bPY-eFKby8OK4n0Zf3l-uZ1fx9XK-mE2v45xnMo1FIUFww6lUBlshmaCSciFEYZXcWG55yoXlimNjLd0AZIyCzAtiOS0UY-w0ej327lz7vQff6br0OVSVaaDtvZY4Y1JS9U-QS5EJhUUAz_4Ct23vmvAJTQlmGWGCBOh8hHLXeu-g0DtX1sYdNMF6sKi3elClB1V6sKiPFvU-hF8eX-g3Ndg_oqO2ALw6AsbnpiqcafLS_-aUoowOk74dsZ9lBYf_mEB_mK-GU2iIx4bSd7B_aDDuXgcXkutvn-aac3wxF7OPOmW_ANZxxlY</recordid><startdate>199910</startdate><enddate>199910</enddate><creator>McCusker, Jane</creator><creator>Bellavance, Francois</creator><creator>Cardin, Sylvie</creator><creator>Trepanier, Sylvain</creator><creator>Verdon, Josee</creator><creator>Ardman, Orly</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>199910</creationdate><title>Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool</title><author>McCusker, Jane ; Bellavance, Francois ; Cardin, Sylvie ; Trepanier, Sylvain ; Verdon, Josee ; Ardman, Orly</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5874-6f7e65a5279a0d67362725666fd97bd5d5456d5950add2bee832e7cf1d52f9333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis. Health state</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Elderly people</topic><topic>Emergency admission</topic><topic>emergency department</topic><topic>Emergency Service, Hospital</topic><topic>Emergency services</topic><topic>Epidemiology</topic><topic>Female</topic><topic>functional decline</topic><topic>General aspects</topic><topic>Geriatric Assessment</topic><topic>Health risk assessment</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Older people</topic><topic>Outcomes</topic><topic>Prospective Studies</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Questionnaires</topic><topic>Reproducibility of Results</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Screening</topic><topic>Sensitivity and Specificity</topic><topic>Surveys and Questionnaires</topic><topic>validity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McCusker, Jane</creatorcontrib><creatorcontrib>Bellavance, Francois</creatorcontrib><creatorcontrib>Cardin, Sylvie</creatorcontrib><creatorcontrib>Trepanier, Sylvain</creatorcontrib><creatorcontrib>Verdon, Josee</creatorcontrib><creatorcontrib>Ardman, Orly</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McCusker, Jane</au><au>Bellavance, Francois</au><au>Cardin, Sylvie</au><au>Trepanier, Sylvain</au><au>Verdon, Josee</au><au>Ardman, Orly</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>1999-10</date><risdate>1999</risdate><volume>47</volume><issue>10</issue><spage>1229</spage><epage>1237</epage><pages>1229-1237</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVES: To develop a self‐report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long‐term hospitalization, or a clinically significant decrease in functional status.
DESIGN: Prospective (6‐month) follow‐up study of a cohort of ED patients aged 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 were excluded if they could not be interviewed either because of their medical 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) scale. 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‐report 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 defined by disposition (admitted or released from ED), language of questionnaire 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 health outcomes and those with current disability.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>10522957</pmid><doi>10.1111/j.1532-5415.1999.tb05204.x</doi><tpages>9</tpages></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 1999-10, Vol.47 (10), p.1229-1237 |
| issn | 0002-8614 1532-5415 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70837729 |
| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Aged, 80 and over Analysis. Health state Biological and medical sciences Chi-Square Distribution Clinical outcomes Cohort Studies Elderly people Emergency admission emergency department Emergency Service, Hospital Emergency services Epidemiology Female functional decline General aspects Geriatric Assessment Health risk assessment Hospitals Humans Logistic Models Male Medical sciences Older people Outcomes Prospective Studies Public health. Hygiene Public health. Hygiene-occupational medicine Questionnaires Reproducibility of Results Risk assessment Risk Factors ROC Curve Screening Sensitivity and Specificity Surveys and Questionnaires validity |
| title | Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool |
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