title: The Risk Instrument for Screening in the Community (RISC): a new instrument for predicting risk of adverse outcomes in community dwelling older adults.
abstract: BACKGROUND
  Predicting risk of adverse healthcare outcomes, among community dwelling older adults, is difficult. The Risk Instrument for Screening in the Community (RISC) is a short (2-5 min), global subjective assessment of risk created to identify patients' 1-year risk of three outcomes:institutionalisation, hospitalisation and death.
  
  
  METHODS
  We compared the accuracy and predictive ability of the RISC, scored by Public Health Nurses (PHN), to the Clinical Frailty Scale (CFS) in a prospective cohort study of community dwelling older adults (n = 803), in two Irish PHN sectors. The area under the curve (AUC), from receiver operating characteristic curves and binary logistic regression models, with odds ratios (OR), compared the discriminatory characteristics of the RISC and CFS.
  
  
  RESULTS
  Follow-up data were available for 801 patients. The 1-year incidence of institutionalisation, hospitalisation and death were 10.2, 17.7 and 15.6 % respectively. Patients scored maximum-risk (RISC score 3,4 or 5/5) at baseline had a significantly greater rate of institutionalisation (31.3 and 7.1 %, p < 0.001), hospitalisation (25.4 and 13.2 %, p < 0.001) and death (33.5 and 10.8 %, p < 0.001), than those scored minimum-risk (score 1 or 2/5). The RISC had comparable accuracy for 1-year risk of institutionalisation (AUC of 0.70 versus 0.63), hospitalisation (AUC 0.61 versus 0.55), and death (AUC 0.70 versus 0.67), to the CFS. The RISC significantly added to the predictive accuracy of the regression model for institutionalisation (OR 1.43, p = 0.01), hospitalisation (OR 1.28, p = 0.01), and death (OR 1.58, p = 0.001).
  
  
  CONCLUSIONS
  Follow-up outcomes matched well with baseline risk. The RISC, a short global subjective assessment, demonstrated satisfactory validity compared with the CFS.
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. rocaoimh@hotmail.com.|COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland. rocaoimh@hotmail.com.|Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland. rocaoimh@hotmail.com.
authors.forename: Rónán
authors.initials: R
authors.lastname: O'Caoimh
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. xhandgy@gmail.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.affiliation: UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON, M5B 2 J1, Canada. info@statshelp.ca.
authors.forename: Anton
authors.initials: A
authors.lastname: Svendrovski
authors.affiliation: Centre for Public Health Nursing, Ballincollig and Bishopstown, Co, Cork, Ireland. elizabeth.healy@hse.ie.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Healy
authors.affiliation: Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland. elizabeth.oconnell@hse.ie.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland. gabrielle.okeeffe@hse.ie.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Keeffe
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. una.cronin@ucc.ie.
authors.forename: Una
authors.initials: U
authors.lastname: Cronin
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. estera_igras@hotmail.com.
authors.forename: Estera
authors.initials: E
authors.lastname: Igras
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. eoh@ucc.ie.
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Herlihy
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. carol.fitzgerald@ucc.ie.
authors.forename: Carol
authors.initials: C
authors.lastname: Fitzgerald
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. e.weathers@ucc.ie.|School of Nursing and Midwifery, University College Cork, Cork, Ireland. e.weathers@ucc.ie.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weathers
authors.affiliation: School of Nursing and Midwifery, University College Cork, Cork, Ireland. Patricia.Leahy@ucc.ie.
authors.forename: Patricia
authors.initials: P
authors.lastname: Leahy-Warren
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. n.cornally@ucc.ie.|School of Nursing and Midwifery, University College Cork, Cork, Ireland. n.cornally@ucc.ie.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cornally
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. W.Molloy@ucc.ie.|COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland. W.Molloy@ucc.ie.
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D057187:Independent Living / Q000639:trends; D007326:Institutionalization / Q000639:trends*; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000639:trends*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends