title: Risk prediction in the community: A systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adults.
abstract: Few case-finding instruments are available to community healthcare professionals. This review aims to identify short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death. Data sources included PubMed and the Cochrane library. Data on outcome measures, patient and instrument characteristics, and trial quality (using the Quality In Prognosis Studies [QUIPS] tool), were double-extracted for derivation-validation studies in community-dwelling older adults (>50 years). Forty-six publications, representing 23 unique instruments, were included. Only five were externally validated. Mean patient age range was 64.2-84.6 years. Most instruments n=18, (78%) were derived in North America from secondary analysis of survey data. The majority n=12, (52%), measured more than one outcome with hospitalisation and the Probability of Repeated Admission score the most studied outcome and instrument respectively. All instruments incorporated multiple predictors. Activities of daily living n=16, (70%), was included most often. Accuracy varied according to instruments and outcomes; area under the curve of 0.60-0.73 for hospitalisation, 0.63-0.78 for functional decline, 0.70-0.74 for institutionalisation and 0.56-0.82 for death. The QUIPS tool showed that 5/23 instruments had low potential for bias across all domains. This review highlights the present need to develop short, reliable, valid instruments to case-find older adults at risk in the community.
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland. Electronic address: rocaoimh@hotmail.com.
authors: Rónán
authors: R
authors: O'Caoimh
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland.
authors: Nicola
authors: N
authors: Cornally
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland.
authors: Elizabeth
authors: E
authors: Weathers
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland.
authors: Ronan
authors: R
authors: O'Sullivan
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland.
authors: Carol
authors: C
authors: Fitzgerald
authors: Institute for Research Primary Healthcare, Jordi Gol University, Barcelona, Spain.
authors: Francesc
authors: F
authors: Orfila
authors: School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia.
authors: Roger
authors: R
authors: Clarnette
authors: Institute of Biomedical Sciences Abel Salazar - University of Porto, Porto, Portugal.
authors: Constança
authors: C
authors: Paúl
authors: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
authors: D William
authors: DW
authors: Molloy
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012111:Residence Characteristics; D012306:Risk
keywords: Adverse healthcare outcomes; Community; Older adults; Risk prediction; Screening