Identification of Seniors at Risk (ISAR) in the emergency room: A prospective study João Paulo de Almeida Tavares a,⇑ , Pedro Sá-Couto b , Marie Boltz c , Elizabeth Capezuti d a Coimbra Hospital and Universitary Center, Rua António José de Almeida, lote 12, 6° Esquerdo, 3000-046 Coimbra, Portugal b Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal c Penn State College of Nursing, Nursing Sciences Bldg, University Park, PA 16802, United States d Hunter-Bellevue School of Nursing Hunter College of CUNY, Brookdale Campus West, Room 500A 425 E, 25th Street Mailbox #925 NY, NY 10010, United States article info Article history: Received 1 November 2016 Received in revised form 12 April 2017 Accepted 31 May 2017 Available online xxxx Keywords: Aged Emergency Risk screening Predictive validity abstract Introduction: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screen- ing tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. Methods: This was a prospective single-center observational study in a Portuguese urban university hos- pital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated. Results: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff  2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR = 2.43, 95% CI 1.35–4.35, p < 0.01) and late returns to the ED (AO = 1.70, 95% CI 1.04–2.79, p < 0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180 days. Discussion: The ISAR predicted returns to EDs at 30 and 180 days for OAs at risk, but was unable to pre- dict early or late hospital readmission. Ó 2017 Published by Elsevier Ltd. 1. Introduction Portugal is the fifth oldest country in the world. In 2011, 19% of the population was aged 65 or higher [1] and this is expected to rise to 34.7% by 2030 [2]. The aging Portuguese population con- tributes to the increased use of emergency services by older adults (OA), which is often associated with unit overcrowding [3,4]. The higher prevalence of chronic disease susceptible to frequent exacerbations, polypharmacy, and complex social, functional and cognitive situations, contribute to higher ED use by OAs [5,6]. These factors also contribute to their increased vulnerability to adverse outcomes [7], including longer lengths of stay, higher rates of ED return in 30 (10–20%), 90 (8% have more than three visits during this time), and 180 days, hospitalization, functional decline and mortality [7–13]. The screening of high-risk OAs in the ED is a key strategy for promoting optimal outcomes, promoting early identification and targeted interventions to .prevent and resolve adverse outcomes [6]. Various instruments have been developed since the 1990 s that seek to identify the risk factors (e.g. functional decline, cognitive impairment) that predispose older emergency patients to adverse outcomes [6]. Among the tools (e.g. Identification of Seniors at Risk (ISAR), Triage Risk Screening Tool (TRST) and the Silver Code) reported in a systematic review, the ISAR was an instrument used in most studies (n = 19) and included more patients (n = 14, 440) [3]. These studies were conducted in diverse healthcare contexts and countries, and support ISAR as a suitable tool for screening older adults in the ED [3,6,14]. The predictive validity of ISAR for adverse outcomes includes the risk of mortality, long term care placement, functional decline, ED return and hospital readmission. This tool was originally developed and validated in a Canadian set- ting [15]. The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. For this reason, many European countries have translated, adapted and validated the ISAR [10,12,13,16–18]. In Portugal, only translation and cultural adaptation was performed [19]. However, researchers and clinicians need reliable and valid instruments in the Portuguese language to provide better care to older adults in http://dx.doi.org/10.1016/j.ienj.2017.05.008 1755-599X/Ó 2017 Published by Elsevier Ltd. ⇑ Corresponding author. E-mail addresses: enf.joaotavares@hotmail.com (J.P. de A. Tavares), p.sa.couto@ ua.pt (P. Sá-Couto), mpb40@psu.edu (M. Boltz), ec773@hunter.cuny.edu (E. Capezuti). International Emergency Nursing xxx (2017) xxx–xxx Contents lists available at ScienceDirect International Emergency Nursing journal homepage: www.elsevier.com/locate/aaen Please cite this article in press as: Tavares J.P. de A. et al. Identification of Seniors at Risk (ISAR) in the emergency room: A prospective study. Int. Emerg. Nurs. (2017), http://dx.doi.org/10.1016/j.ienj.2017.05.008