Which Part of a Short, Global Risk Assessment, the Risk Instrument for Screening in the Community, Predicts Adverse Healthcare Outcomes?
The Risk Instrument for Screening in the Community (RISC) is a short, global risk assessment to identify community-dwelling older adults' one-year risk of institutionalisation, hospitalisation, and death. We investigated the contribution that the three components of the RISC (concern, its severity, and the ability of the caregiver network to manage concern) make to the accuracy of the instrument, across its three domains (mental state, activities of daily living (ADL), and medical state), by comparing their accuracy to other assessment instruments in the prospective Community Assessment of Risk and Treatment Strategies study. RISC scores were available for 782 patients. Across all three domains each subtest more accurately predicted institutionalisation compared to hospitalisation or death. The caregiver network's ability to manage ADL more accurately predicted institutionalisation (AUC 0.68) compared to hospitalisation (AUC 0.57, P = 0.01) or death (AUC 0.59, P = 0.046), comparing favourably with the Barthel Index (AUC 0.67). The severity of ADL (AUC 0.63), medical state (AUC 0.62), Clinical Frailty Scale (AUC 0.67), and Charlson Comorbidity Index (AUC 0.66) scores had similar accuracy in predicting mortality. Risk of hospitalisation was difficult to predict. Thus, each component, and particularly the caregiver network, had reasonable accuracy in predicting institutionalisation. No subtest or assessment instrument accurately predicted risk of hospitalisation.
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland ; COLLAGE (Collaboration on Ageing), University College Cork, Cork City and Louth Age Friendly County Initiative, County Louth, Ireland.
Rónán
R
O'Caoimh
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
Carol
C
FitzGerald
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
Una
U
Cronin
UZIK Consulting Inc., 86 Gerrard Street E, Unit 12D, Toronto, ON, Canada M5B 2J1.
Anton
A
Svendrovski
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
Yang
Y
Gao
Centre for Public Health Nursing, Ballincollig and Bishopstown, County Cork, Ireland.
Elizabeth
E
Healy
Centre for Public Health Nursing, Mahon and Ballintemple, Cork, Ireland.
Elizabeth
E
O'Connell
Health Service Executive, South Lee, St. Finbarr's Hospital, Cork, Ireland.
Gabrielle
G
O'Keeffe
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
Eileen
E
O'Herlihy
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland ; School of Nursing & Midwifery, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
Elizabeth
E
Weathers
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland ; School of Nursing & Midwifery, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
Nicola
N
Cornally
School of Nursing & Midwifery, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
Patricia
P
Leahy-Warren
Primary Healthcare University Research Institute, IDIAP Jordi Gol, Barcelona, Spain.
Francesc
F
Orfila
UNIFAI/ICBAS, Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
Constança
C
Paúl
School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
Roger
R
Clarnette
Centre for Gerontology and Rehabilitation, University College Cork, St. Finbarr's Hospital, Douglas Road, Cork, Ireland ; COLLAGE (Collaboration on Ageing), University College Cork, Cork City and Louth Age Friendly County Initiative, County Louth, Ireland.
D William
DW
Molloy