To modify and validate in primary health care the Identification of Seniors At Risk (ISAR) screening questionnaire to identify older persons at increased risk of functional decline and to compare this strategy with risk stratification by age alone.
Study Design and Setting
Prospective development (n = 790) and validation cohorts (n = 2,573) of community-dwelling persons aged ≥70 years. Functional decline at 12 months was defined as an increase of at least one point on the modified Katz–activities of daily living index score compared with baseline or death.
Three items were independently associated with functional decline: age (odds ratio [OR]: 1.06 per year; 95% confidence interval [CI]: 1.02, 1.10), dependence in instrumental activities of daily living (OR: 2.17; 95% CI: 1.46, 3.22), and impaired memory (OR: 2.22; 95% CI: 1.41, 3.51). The area under the receiver operating characteristics curve (AUC) range of the ISAR-primary care model was 0.67–0.70, and 40.6% was identified at increased risk. Validation yielded an AUC range of 0.63–0.64. Age ≥75 years alone yielded an AUC range of 0.56–0.57 and identified 55.4% at increased risk in the development cohort.
Although the ISAR–Primary Care (ISAR-PC) has moderate predictive value, application of the ISAR-PC is more efficient than selection based on age alone in identifying persons at increased risk of functional decline.