title: A tool for prediction of risk of rehospitalisation and mortality in the hospitalised elderly: secondary analysis of clinical trial data.
abstract: OBJECTIVE
  To construct and internally validate a risk score, the '80+ score', for revisits to hospital and mortality for older patients, incorporating aspects of pharmacotherapy. Our secondary aim was to compare the discriminatory ability of the score with that of three validated tools for measuring inappropriate prescribing: Screening Tool of Older Person's Prescriptions (STOPP), Screening Tool to Alert doctors to Right Treatment (START) and Medication Appropriateness Index (MAI).
  
  
  METHODS
  Two acute internal medicine wards at Uppsala University hospital. Patient data were used from a randomised controlled trial investigating the effects of a comprehensive clinical pharmacist intervention.
  
  
  METHODS
  Data from 368 patients, aged 80 years and older, admitted to one of the study wards.
  
  
  METHODS
  Time to rehospitalisation or death during the year after discharge from hospital. Candidate variables were selected among a large number of clinical and drug-specific variables. After a selection process, a score for risk estimation was constructed. The 80+ score was internally validated, and the discriminatory ability of the score and of STOPP, START and MAI was assessed using C-statistics.
  
  
  RESULTS
  Seven variables were selected. Impaired renal function, pulmonary disease, malignant disease, living in a nursing home, being prescribed an opioid or being prescribed a drug for peptic ulcer or gastroesophageal reflux disease were associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked to a lower risk of the outcome. These variables made up the components of the 80+ score. The C-statistics were 0.71 (80+), 0.57 (STOPP), 0.54 (START) and 0.63 (MAI).
  
  
  CONCLUSIONS
  We developed and internally validated a score for prediction of risk of rehospitalisation and mortality in hospitalised older people. The score discriminated risk better than available tools for inappropriate prescribing. Pending external validation, this score can aid in clinical identification of high-risk patients and targeting of interventions.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Alassaad
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Melhus
authors.affiliation: Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hammarlund-Udenaes
authors.affiliation: Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Bertilsson
authors.affiliation: Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Gillespie
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use; D005853:Geriatrics / Q000592:standards; D006299:Health Services for the Aged; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D008297:Male; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D005765:Gastrointestinal Agents; D004364:Pharmaceutical Preparations
keywords: GERIATRIC MEDICINE; INTERNAL MEDICINE; Organisation of health services < HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Prediction model; Risk-estimation; THERAPEUTICS (pharmacotherapy)