title: Optimal screening for increased risk for adverse outcomes in hospitalised older adults.
abstract: BACKGROUND
  Screening for frailty might help to prevent adverse outcomes in hospitalised older adults.
  
  
  OBJECTIVE
  To identify the most predictive and efficient screening tool for frailty.
  
  
  METHODS
  Two consecutive observational prospective cohorts in four hospitals in the Netherlands.
  
  
  METHODS
  Patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.
  
  
  METHODS
  Screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed.
  
  
  RESULTS
  Follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58-0.66), but the percentage of positively screened patients (13-72%), sensitivity (24-89%) and specificity (35-91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70-80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort.
  
  
  CONCLUSIONS
  The VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.
authors.affiliation: Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands.
authors.forename: Noor
authors.initials: N
authors.lastname: Heim
authors.affiliation: Department of Psychiatry, LUMC, Leiden, The Netherlands.
authors.forename: Ester M
authors.initials: EM
authors.lastname: van Fenema
authors.affiliation: Department of Geriatrics, Diaconessenhuis Leiden, Leiden, The Netherlands.
authors.forename: Annelies W E
authors.initials: AW
authors.lastname: Weverling-Rijnsburger
authors.affiliation: Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands.
authors.forename: Jolien P
authors.initials: JP
authors.lastname: Tuijl
authors.affiliation: Department of Geriatric Medicine, Rijnland Hospital, Leiden, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Jue
authors.affiliation: Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Oleksik
authors.affiliation: Institute for Research and PhD Supervision, The Hague, The Netherlands.
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Verschuur
authors.affiliation: Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jasper S
authors.initials: JS
authors.lastname: Haverkamp
authors.affiliation: Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands.
authors.forename: Gerard Jan
authors.initials: GJ
authors.lastname: Blauw
authors.affiliation: Department of Psychiatry, LUMC, Leiden, The Netherlands.
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
authors.affiliation: Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands Leyden Academy on Vitality and Ageing, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D003693:Delirium / Q000175:diagnosis / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D009426:Netherlands; D009483:Neuropsychological Tests; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: frailty; hospitalised older adults; predictive power; screening