Predicting older adults who return to the hospital or die within 30   days of XXXX care using the ISAR tool: subjective versus objective risk factors.

@entity1 @entity341 @entity204
BACKGROUND: We sought to evaluate the ability of the Identification of Seniors At Risk (ISAR) tool to differentiate between older adult @entity1 having a poor outcome within 30   days of @entity341 ( @entity341 ) care and those who do not. We compare prognostic accuracy of subjective versus objective risk factors. METHODS: 202 community-dwelling @entity1 age 65   years and older presenting to two EDs were prospectively enrolled. @entity1 completed the six-question ISAR and objective testing (cognition, ambulation, vision). We reviewed electronic medical records for current medications, hospitalisations in the past six   months, @entity341 disposition, length of hospital stay, subsequent @entity341 visits or inpatient admissions or @entity204 at 30   days. @entity1 were given a point for each risk factor present; subjective and objective risk factors were scored separately. We tested ability of individual risk factors and scores to predict a composite outcome of subsequent @entity341 visit, postdischarge hospitalisation or @entity204 by day 30 after the index @entity341 visit. We computed receiver operating curve area under the curves (AUC) to determine tool discrimination. RESULTS: 23% of @entity1 had a poor 30-day outcome. The optimum subjective ISAR cut-off score for screening was >= 2, which was present in 84% of @entity1 , had a sensitivity of 91% and specificity of 19%. Using the subjective ISAR tool, the AUC was 0.66. The optimum objective ISAR-related risk cut-off score for screening was >= 3, which was present in 82% of @entity1 , had a sensitivity of 87% and specificity of 40%. Using the objective ISAR-related tool, the AUC was 0.69. CONCLUSIONS: The self-reported ISAR tool did not discriminate well between older adults with or without 30-day hospital revisit or @entity204 . An optimum score of >= 2 would identify many older adults at no apparent increased risk of poor outcomes at 30   days. Using objective ISAR-related risk factors did not improve overall discrimination.
