title: Screening tools to identify hospitalised elderly patients at risk of functional decline: a systematic review.
abstract: BACKGROUND
  The elderly patient admitted to the emergency department (ED) of an acute care hospital is at risk of declining functionally, both during the stay at the hospital as an inpatient and postdischarge. Accurate and early identification of this population may lead to improved outcomes through targeted early interventions.
  
  
  OBJECTIVE
  To identify, critically appraise and characterise available screening tools to screen for elderly patients at risk of functional decline presenting to the ED of acute care hospitals.
  
  
  METHODS
  Screening tools administered in the ED to identify elderly patients at risk of functional decline during hospital stay and/or postdischarge. All primary quantitative and qualitative study types were included. Population included age > 65 years presenting to the ED of an acute care hospital.
  
  
  RESULTS
  Six studies reporting on five screening tools were identified. Two instruments reported acceptable discriminative ability; however, one of these has not been prospectively validated. No studies that validated any of the instruments in a setting other than the development setting were identified. A single study reported good test-retest reliability data for one instrument, the Identification of Seniors at Risk.
  
  
  CONCLUSIONS
  This review was unable to identify a 'gold standard' tool to screen for risk of functional decline for the elderly patient admitted to the ED. Further research should be carried out to determine adjunctive processes to increase the accuracy of the identification of elderly patients at risk of functional decline. Further research should also be carried out to determine the appropriateness, or generalisability of these tools in different healthcare settings.
authors.affiliation: Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, Australia. matt.sutton@health.sa.gov.au
authors.forename: M
authors.initials: M
authors.lastname: Sutton
authors.forename: K
authors.initials: K
authors.lastname: Grimmer-Somers
authors.forename: L
authors.initials: L
authors.lastname: Jeffries
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000368:Aged; D004636:Emergency Service, Hospital; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D012307:Risk Factors; D012680:Sensitivity and Specificity