Perceived risk of institutionalization, hospitalization, and death in oldest old primary care patients

• Autor(a) principal: Brandão, Daniela
• Data de Publicação: 2020
• Outros Autores: Ribeiro, Óscar, Teixeira, Laetitia, Paúl, Constança
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/37466
• topic: Portugal; Oldest old; Primary care patients; Hospitalization; Institutionalization; Death

Objectives: This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns. Method: GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes. Results: The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of in- stitutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68). Conclusions: The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for in- stitutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument’s use.