title: Components of the Risk Instrument for Screening in the Community (RISC) that Correlate with Public Health Nurses' Perception of Risk.
abstract: BACKGROUND
  Functional decline and frailty are common in community-dwelling older adults, leading to an increased risk of adverse outcomes.
  
  
  OBJECTIVE
  To examine the factors that public health nurses perceive to cause risk of three adverse outcomes: institutionalisation, hospitalisation, and death, in older adults, using the Risk Instrument for Screening in the Community (RISC).
  
  
  METHODS
  A quantitative, correlational, descriptive design was used.
  
  
  METHODS
  A sample of 803 community-dwellers, aged over 65 years receiving regular follow-up by public health nurses. Procedure and Measurements: Public health nurses (n=15) scored the RISC and the Clinical Frailty Scale (CFS) on patients in their caseload. We examined and compared correlations between the severity of concern and ability of the caregiver network to manage these concerns with public health nurses' perception of risk of the three defined adverse outcomes.
  
  
  RESULTS
  In total, 782 RISC scores were available. Concern was higher for the medical state domain (686/782,88%) compared with the mental state (306/782,39%) and activities of daily living (595/782,76%) domains. Concern was rated as severe for only a small percentage of patients. Perceived risk of institutionalisation had the strongest correlation with concern over patients mental state,(r=0.53), while risk of hospitalisation,(r=0.53) and death,(r=0.40) correlated most strongly with concern over the medical state. Weaker correlations were found for the other domains and RISC scores. The CFS most strongly correlated with the ADL domain,(r=0.78).
  
  
  CONCLUSIONS
  Although the prevalence of concern was high, it was mostly rated as mild. Perceived risk of institutionalisation correlated most with concern over the ability of caregiver networks to manage patients' mental state, while risk of hospitalisation and death correlated with patients' medical state. The findings suggest the importance of including an assessment of the caregiver network when examining community-dwelling older adults. Validation of the RISC and public health nurses' ratings are now required.
authors.affiliation: Dr Rónán O'Caoimh, Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Douglas road, Cork City, Ireland, Email: rocaoimh@hotmail.com, Phone: +353214901461, Fax: +3534901635.
authors.forename: P
authors.initials: P
authors.lastname: Leahy-Warren
authors.forename: R
authors.initials: R
authors.lastname: O'Caoimh
authors.forename: C
authors.initials: C
authors.lastname: FitzGerald
authors.forename: A
authors.initials: A
authors.lastname: Cochrane
authors.forename: A
authors.initials: A
authors.lastname: Svendrovski
authors.forename: U
authors.initials: U
authors.lastname: Cronin
authors.forename: E
authors.initials: E
authors.lastname: O'Herlihy
authors.forename: N
authors.initials: N
authors.lastname: Cornally
authors.forename: Y
authors.initials: Y
authors.lastname: Gao
authors.forename: E
authors.initials: E
authors.lastname: Healy
authors.forename: E
authors.initials: E
authors.lastname: O'Connell
authors.forename: G
authors.initials: G
authors.lastname: O'Keeffe
authors.forename: S
authors.initials: S
authors.lastname: Coveney
authors.forename: J
authors.initials: J
authors.lastname: McGlynn
authors.forename: C
authors.initials: C
authors.lastname: Fitzgerald
authors.forename: R
authors.initials: R
authors.lastname: Clarnette
authors.forename: D W
authors.initials: DW
authors.lastname: Molloy