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Abstract：
Understanding risk factors for frailty, functional decline and incidence of adverse healthcare outcomes amongst community-dwelling older adults is important to plan population-level health and social care services. We examined variables associated with one-year risk of institutionalisation, hospitalisation and death among patients assessed in their own home by a community-based Aged Care Assessment Team (ACAT) in Western Australia. Frailty and risk were measured using the Clinical Frailty Scale (CFS) and Risk Instrument for Screening in the Community (RISC), respectively. Predictive accuracy was measured from the area under the curve (AUC). Data from 417 patients, median 82 ± 10 years, were included. At 12-month follow-up, 22.5% (n = 94) were institutionalised, 44.6% (n = 186) were hospitalised at least once and 9.8% (n = 41) had died. Frailty was common, median CFS score 6/9 ± 1, and significantly associated with institutionalisation (p = 0.001), hospitalisation (p = 0.007) and death (p < 0.001). Impaired activities of daily living (ADL) measured on the RISC had moderate correlation with admission to long-term care (r = 0.51) and significantly predicted institutionalisation (p < 0.001) and death (p = 0.01). The RISC had the highest accuracy for institutionalisation (AUC 0.76). The CFS and RISC had fair to good accuracy for mortality (AUC of 0.69 and 0.74, respectively), but neither accurately predicted hospitalisation. Home assessment of community-dwelling older patients by an ACAT in Western Australia revealed high levels of frailty, ADL impairment and incident adverse outcomes, suggesting that anticipatory care planning is imperative for these patients.
摘要：
了解脆弱的危险因素，社区老年人的功能下降和不良医疗结果的发生率对于规划人口层面的健康和社会护理服务很重要.我们检查了与一年制度化风险相关的变量，西澳大利亚州社区老年护理评估小组(ACAT)在自己家中评估患者的住院和死亡情况.使用临床虚弱量表（CFS）和社区筛查风险工具（RISC）测量虚弱和风险，分别。从曲线下面积(AUC)测量预测准确性。来自417名患者的数据，中位数82±10年，包括在内。在12个月的随访中，22.5%(n=94)被制度化，44.6％（n=186）至少住院一次，9.8％（n=41）死亡。虚弱是常见的，中位CFS评分6/9±1，与制度化显着相关(p=0.001)，住院（p=0.007）和死亡（p<0.001）。在RISC上测量的日常生活活动（ADL）受损与接受长期护理（r=0.51）具有中度相关性，并显着预测了住院（p<0.001）和死亡（p=0.01）。RISC的制度化准确度最高(AUC0.76)。CFS和RISC对死亡率有相当好的准确性（AUC分别为0.69和0.74），但都不能准确预测住院。西澳大利亚州ACAT对社区居住的老年患者进行的家庭评估显示，身体虚弱程度很高，ADL损害和事件不良结果，这表明对这些患者的预期护理计划势在必行。
