title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  two acute medical units in the East Midlands, UK.
  
  
  METHODS
  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.
authors.affiliation: Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Floor B, Medical School Queens Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Judi
authors.initials: J
authors.lastname: Edmans
authors.forename: Lucy
authors.initials: L
authors.lastname: Bradshaw
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.forename: Matthew
authors.initials: M
authors.lastname: Franklin
authors.forename: Vladislav
authors.initials: V
authors.lastname: Berdunov
authors.forename: Rachel
authors.initials: R
authors.lastname: Elliott
authors.forename: Simon P
authors.initials: SP
authors.lastname: Conroy
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics*; D004739:England; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D008297:Male; D008603:Mental Health; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012947:Social Work / Q000191:economics; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: acute care; older people; screening