Abstract
Risk stratification to assess healthcare outcomes among older people is challenging due to the interplay of multiple syndromes and conditions. Different short risk-screening tools can assist but the most useful instruments to predict responses and outcomes following interventions are unknown. We examined the relationship between a suite of screening tools and risk of adverse outcomes (pre-determined clinical ‘decline’ i.e., becoming ‘unstable’ or ‘deteriorating’ at 60–90 days, and institutionalisation, hospitalisation and death at 120 days), among community dwellers (n = 88) after admission to a single-centre, Irish, Community Virtual Ward (CVW). The mean age of patients was 82.8 (±6.4) years. Most were severely frail, with mean Clinical Frailty Scale (CFS) scores of 6.8 ± 1.33. Several instruments were useful in predicting ‘decline’ and other healthcare outcomes. After adjustment for age and gender, higher frailty levels, odds ratio (OR) 3.29, (p = 0.002), impaired cognition (Mini Mental State Examination; OR 4.23, p < 0.001), lower mobility (modified FIM) (OR 3.08, p < 0.001) and reduced functional level (Barthel Index; OR 6.39, p < 0.001) were significantly associated with clinical ‘decline’ at 90 days. Prolonged (>30 s) TUG times (OR 1.27, p = 0.023) and higher CFS scores (OR 2.29, p = 0.045) were associated with institutionalisation. Only TUG scores were associated with hospitalisation and only CFS, MMSE and Barthel scores at baseline were associated with mortality. Utilisation of a multidimensional suite of risk-screening tools across a range of domains measuring frailty, mobility and cognition can help predict clinical ‘decline’ for an already frail older population. Their association with other outcomes was less useful. A better understanding of the utility of these instruments in vulnerable populations will provide a framework to inform the impact of interventions and assist in decision-making and anticipatory care planning for older patients in CVW models.
Highlights
A Community Virtual Ward (CVW) was developed in North Dublin, Ireland, to support community-dwelling older persons with frailty to reduce the need for institutional care or emergency department (ED) presentations and to limit the number of unplanned hospital admissions [6]
As the complexity of care needs among community-dwelling older adults increases, it is essential to prioritise those at risk of further deterioration and to identify those that are most likely to respond to and benefit from interventions
This study highlights the utility of several commonly used short risk screening tools employed as part of a CVW model of care to inform assessment of care needs and outcomes among an older and frail cohort
Summary
The World Report on Ageing and Health, conceptualizes the core domains of care as being person-centred, integrated and that enhance activities of daily living with a focus on bridging the gap between achieving the optimal clinical outcomes and supporting day-to-day living that enables people to age and live well [1]. These include underlying determinants of health such as nutrition, access to food and functioning in a safe and healthy environment [1]. An enabler of this is the utilization of screening tools that assess the level of dependency, the environment in which care is delivered and early
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