![]() The objective of this study was to assess geographical validity of existing risk scores as well as of frailty indicators to predict ED visits and unplanned hospitalizations in older home care recipients from six countries. Therefore, we also evaluated the validity of frailty indicators to predict unplanned hospital visits. long-term care admissions, hospitalizations and death), but rarely unplanned hospital visits solely. Validation of frailty indicators has been performed to predict combined adverse events (e.g. It therefore seems reasonable to use a general frailty indicator for stratifying older patients on their risk of unplanned hospital visits. In addition, frailty is associated with higher risk for hospitalizations. It is thus worthy to assess the performance of risk scores across different countries. An accurate validated risk score in one country, might therefore not perform as well in another. Older populations and organization of emergency care differ between countries. ![]() Geographical validation, which validates in samples from other geographical areas, provides strong evidence on the performance and generalizability of a risk score. These studies however all stressed the need for external validation. To allow a timely intervention, several risk scores have been developed to identify older adults at risk of future ED visits or unplanned hospitalizations. causing rapid functional decline and death. Emergency department (ED) visits and unplanned hospitalizations can negatively affect older people’s lives, e.g. This consequently increases the risk of unplanned hospital use. Community-dwelling older adults are more prone to encounter accidents and suboptimal management of chronic disease. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores.Īgeing in place policies and the reduction of nursing home beds require older adults to live increasingly longer in the community. Therefore, risk scores should be validated regionally before applied to practice. Unplanned hospital visits seem considerably dependent on healthcare context. Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. In other countries, AUCs did not exceed 0.70. ![]() In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 ) and any unplanned hospital visits (AUC 0.73 ). In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 and AUC 0.74 ), respectively). Risk score performance varied across countries. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)). Missing data were handled by multiple imputation. Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. We used the IBenC sample ( n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries. It is unclear whether risk scores developed in one country, perform as well in another. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions.
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