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BMC Geriatr. 2015 Jul 30;15:92. doi: 10.1186/s12877-015-0095-z.

The Risk Instrument for Screening in the Community (RISC): a new instrument for predicting risk of adverse outcomes in community dwelling older adults.

Author information

1
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. rocaoimh@hotmail.com.
2
COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland. rocaoimh@hotmail.com.
3
Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland. rocaoimh@hotmail.com.
4
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. xhandgy@gmail.com.
5
UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON, M5B 2 J1, Canada. info@statshelp.ca.
6
Centre for Public Health Nursing, Ballincollig and Bishopstown, Co, Cork, Ireland. elizabeth.healy@hse.ie.
7
Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland. elizabeth.oconnell@hse.ie.
8
Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland. gabrielle.okeeffe@hse.ie.
9
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. una.cronin@ucc.ie.
10
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. estera_igras@hotmail.com.
11
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. eoh@ucc.ie.
12
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. carol.fitzgerald@ucc.ie.
13
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. e.weathers@ucc.ie.
14
School of Nursing and Midwifery, University College Cork, Cork, Ireland. e.weathers@ucc.ie.
15
School of Nursing and Midwifery, University College Cork, Cork, Ireland. Patricia.Leahy@ucc.ie.
16
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. n.cornally@ucc.ie.
17
School of Nursing and Midwifery, University College Cork, Cork, Ireland. n.cornally@ucc.ie.
18
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland. W.Molloy@ucc.ie.
19
COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland. W.Molloy@ucc.ie.

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).

CONCLUSION:

Follow-up outcomes matched well with baseline risk. The RISC, a short global subjective assessment, demonstrated satisfactory validity compared with the CFS.

PMID:
26224138
PMCID:
PMC4520060
DOI:
10.1186/s12877-015-0095-z
[Indexed for MEDLINE]
Free PMC Article

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