The Identification of Seniors at Risk screening tool is useful for predicting acute readmissions

INTRODUCTION

Acutely ill elderly medical patients have a
higher chance of survival if they are admitted to a specialised geriatric unit instead of a general medical unit. This was shown in a meta-analysis from 2011 which included more than 10,000 elderly patients. The best effect of geriatric intervention is seen when patients are selected carefully. The patients’ need for geriatric intervention was assessed to determine if there was a relation between a screening tool and the assessment made by a specialist of geriatrics (SG).

MATERIAL AND METHODS

A descriptive cohort study was conducted. Patients ≥ 65 years treated during a 14-day period were included. Their mean age was 78 years. Screening with the Identification of Seniors at Risk (ISAR) was performed (n = 198) by the Mobile Geriatric Team (MGT). The patients’ medical journals were assessed retrospectively by the SG to determine any need for assessment and intervention.

RESULTS

53% of the admitted and 77% of the non-admitted patients would have benefitted from assessment by the MGT, and 22% would have benefitted from transfer directly to the Geriatric Unit. The readmitted patients and the patients who died during follow-up had a mean ISAR score of three compared with the non-readmitted patients who had a mean score of two. Patients with either nutritional or cognitive problems, or depression had a mean score of three.

CONCLUSION

To identify elderly patients with a need for comprehensive geriatric assessment, we recommend that triage be supplemented with the ISAR screening. Furthermore, patients with a score of ≥ 2 should be assessed by the MGT so that a post-discharge plan including treatment/rehabilitation and follow-up may be drawn up.

FUNDING

Not relevant.

TRIAL REGISTRATION

The study was approved and registered with the Danish Data Protection Agency under the Capital Region of Denmark’s joint notification of health research (j. no.: 2007-58-0015, AMH-2013-003, I-Suite no.: 02495).

CORRESPONDENCE: Elizabeth Rosted. E-mail: elizabeth.rosted@regionh.dk.

CONFLICTS OF INTEREST: See www.danmedj.dk.

REFERENCE: Dan Med J 2014;61(5):A4828