Screening identifies people or conditions that would benefit from further assessment. The aim is to identify concerns early and avoid further problems in hospital.
Screening usually involves using a prompt to identify various ‘red flags’ or risks associated with the patient. These can include medical, functional and psychosocial risk factors such as:
- being older than 70 and living alone. This includes an increased risk of isolation or loneliness that negatively affects a person's physical and mental health, and increases the risk of mortality1
- a diagnosis of dementia or displaying signs of cognitive impairment
- a recent stay in hospital
- polypharmacy, a history of falls, mobility problems and incontinence
- a recent unexplained weight loss
- a functional limitation with personal care, domestic and community participation
- relying on a significant amount of community service support.
Once we have identified any of the above red flags, we can use targeted screening tools as outlined in the individual topics in this section. Trained staff can conduct screening at any time during a person’s time in hospital. Ideally screening is conducted on admission and regularly throughout the episode of care. Early screening is important in establishing a baseline for monitoring an older person’s level of function and identifying changes in health.
Screening can identify increased risk for functional decline and in many cases trigger an immediate response to mitigate risk until further assessment is possible.
Examples of screening tools
Identification of Seniors at Risk Screening Tool (ISAR)2 - a six item screening tool for seniors in the emergency department.
Fulmer SPICES: An Overall Assessment Tool for Older Adults - SPICES is an alert system that obtains information to help prevent health deterioration in the older adult patient.
UCLA Loneliness Scale - a set of three questions currently recommended in the International Consortium for Health Outcome Measures (ICHOM) to measure if an older person is feeling lonely
1. Campaign to End Loneliness, Threat to health, [Accessed 28 October 2016].
2. McCusker, J., Bellavance, F., Cardin, S., Trepanier, S., Verdon, J., Ardman, M. Detection of older people at increased risk of adverse health outcomes after an emergency visit: The ISAR Screening Tool. Journal of the American Geriatric Society, 1999. 47(10): 1229-37.