Designing an Elderly Hospital Admission Risk Prediction Model in Iran’s Hospitals

Mohammad R. Maleki, Farzaneh Doosty, Mohammad H. Yarmohammadian, Vahid Rasi, Elizabeth (Ibby) Tanner


Background: The identification of elderly at risk of new functional disabilities in activities of daily living at admission to the hospital may facilitate referral for purposive interventions to prevent decline and institutionalization. This study was aimed at designing a risk prediction model for identifying the elderly at risk of admission in Iran’s hospitals.

Materials and Methods: This is a cross‑sectional descriptive study conducted in 2017. In order to formulate and validate a prediction model, the study was done in two development and validation cohort study. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow‑up compared with preadmission status.

Results: In development cohort, the mean age was 71 years including 54% of men and 46% women, 22% of men and 17% of women experienced functional decline after 3 months. In the validation cohort, the mean age was 70 years, including 49% of men and 51% women, 19% of men and 15% of women, functional decline after 3 months was observed.

Conclusion: On the basis of the findings, aging at risk of hospital admission can be identified by easy designed model with four questions: (1) Is the patient’s age more than 85 years? (2) Does the patient’s mini mental status <22? (3) Does the patient need help for using general transporting? (4) Has the patient lost weight <5% over the past 6 months and body mass index <18.5? And also geriatrics experts can use the designed model as a predictive tool in order to improve the quality level of healthcare services to elderly as a vulnerable and high risk group. The important point of model is easy to use even for nonspecialists


Admission; aged; hospitals; Iran; risk

Full Text:



Boogar IR, Rostami R. The psychosocial and demographical risk

factors of cancer (Tehran 2011). J Kermanshah Univ Med Sci


D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M,

Massaro JM, et al. General cardiovascular risk profile for use

in primary care: The Framingham heart study. Circulation


Rahimiyan E. The risk factors of heart failure in patients with

diabetes type 2, prediction of social, psycological and patient

characters. Psycol Prin 2011;51:294‑78.

Billings J, Blunt I, Steventon A, Georghiou T, Lewis G,

Bardsley M. Development of a predictive model to identify

inpatients at risk of re‑admission within 30 days of

discharge (PARR‑30). BMJ Open 2012;2:e001667.

Soong J, Poots A, Scott S, Donald K, Bell D. Developing and

validating a risk prediction model for acute care based on frailty

syndromes. BMJ Open 2015;5:e008457.

Moran JL, Solomon PJ, Peisach AR, Martin J. New models for

old questions: Generalized linear models for cost prediction.

J Eval Clin Pract 2007;13:381‑9.

Hansen LO, Young RS, Hinami K, Leung A, Williams MV.

Interventions to reduce 30‑day rehospitalization: A systematic

review. Ann Intern Med 2011;155:520‑8.

Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C,

Freeman M, et al. Risk prediction models for hospital

readmission: A systematic review. JAMA 2011;306:1688‑98.

Hippisley‑Cox J, Coupland C. Development and validation of

risk prediction algorithm (QThrombosis) to estimate future risk

of venous thromboembolism: Prospective cohort study. BMJ


Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of medicare coordinated care demonstration

programs that cut hospital admissions of high‑risk patients.

Health Affairs 2012;31:1156‑66.

Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, et al. Risk factors and screening instruments to

predict adverse outcomes for undifferentiated older emergency

department patients: A systematic review and meta-analysis.

Acad Emerg Med 2015;22:1‑21.

O’Connor CM, Mentz RJ, Cotter G, Metra M, Cleland JG,

Davison BA, et al. The PROTECT in-hospital risk model: 7-day

outcome in patients hospitalized with acute heart failure and

renal dysfunction. Eur J Heart Fail 2012;14:605‑12.

Saposnik G, Kapral MK, Liu Y, Hall R, O’donnell M,

Raptis S, et al. IScore: A risk score to predict death early

after hospitalization for an acute ischemic stroke. Circulation


Hoffmann S, Malzahn U, Harms H, Koennecke H‑C, Berger K,

Kalic M, et al. Development of a clinical score (A2DS2)

to predict pneumonia in acute ischemic stroke. Stroke


Akgün KM, Gordon K, Pisani M, Fried T, McGinnis KA, Tate JP,

et al. Risk factors for hospitalization and medical intensive care

unit (MICU) admission among HIV infected veterans. J Acquir

Immune Defic Syndr 2013;62:52‑9.

Dubberke ER, Yan Y, Reske KA, Butler AM, Doherty J, Pham V, et al. Development and validation of a Clostridium difficile

infection risk prediction model. Infect Control Hosp Epidemiol


Cohen ME, Bilimoria KY, Ko CY, Hall BL. Development

of an American college of surgeons national surgery quality

improvement program: Morbidity and mortality risk calculator

for colorectal surgery. J Am Coll Surg 2009;208:1009‑16.

Hoogerduijn JG, Schuurmans MJ, Duijnstee MS, De Rooij SE,

Grypdonck MF. A systematic review of predictors and screening

instruments to identify older hospitalized patients at risk for

functional decline. J Clin Nurs 2007;16:46‑57.

Morgan EE, Iudicello JE, Weber E, Duarte NA, Riggs PK,

Delano‑Wood L, et al. Synergistic effects of HIV infection and

older age on daily functioning. J Acquir Immune Defic Syndr


Akbari S, Lyden PD, Kamali M, Akbarfahimi M. Correlations

among impairment, daily activities and thinking operations after

stroke. NeuroRehabilitation 2013;33:153‑60.

Hoops S, Nazem S, Siderowf A, Duda J, Xie S, Stern M,

et al. Validity of the MoCA and MMSE in the detection

of MCI and dementia in Parkinson disease. Neurology


Barone P, Antonini A, Colosimo C, Marconi R, Morgante L,

Avarello TP, et al. The PRIAMO study: A multicenter assessment

of nonmotor symptoms and their impact on quality of life in

Parkinson’s disease. Mov Disord 2009;24:1641‑9.

Seyyediyan MFM, Norouziyan M, Nejat S, Delavar A,

Qasemzade H. Detemining of validity of MMSE. Med Counc

Islamic Repulic Iran 2007;25:408‑16.

Mirmiran PPH, Hamayeli H, Kavyan F, Azizi F. Validity and

reliability evaluation of malnutrition screening questionnaire

during admission to hospital. Nutr Sci Food Technol Iran


Viret O, Schwarz J, Senn N, Mueller Y. «It’s normal to get

old and weak»: Should functional decline be addressed

with elderly patients in family medicine? Rev Med Suisse


Arnold AM, Newman AB, Cushman M, Ding J, Kritchevsky S.

Body weight dynamics and their association with physical

function and mortality in older adults: The cardiovascular health

study. J Gerontol 2010;65:63‑70.

Gill TM, Murphy TE, Barry LC, Allore HG. Risk factors

for disability subtypes in older persons. J Am Geriatr Soc


Rothman MD, Leo-Summers L, Gill TM. Prognostic

significance of potential frailty criteria. J Am Geriatr Soc


Ritchie CS, Locher JL, Roth DL, McVie T, Sawyer P, Allman R.

Unintentional weight loss predicts decline in activities of daily

living function and life‑space mobility over 4 years among

community‑dwelling older adults. J Gerontol A: Biol Sci Med

Sci 2008;63:67‑75.

Jacobs JM, Cohen A, Hammerman‑Rozenberg R, Azoulay D,

Maaravi Y, Stessman J. Going outdoors daily predicts long‑term

functional and health benefits among ambulatory older people.

J Aging Health 2008;20:259‑72.

Al Snih S, Markides KS, Ottenbacher KJ, Raji MA. Hand

grip strength and incident ADL disability in elderly Mexican

Americans over a seven‑year period. Aging Clin Exp Res


Stessman J, Hammerman-Rozenberg R, Maaravi Y, Cohen A.

Effect of exercise on ease in performing activities of daily

living and instrumental activities of daily living from age 70 to 77: The Jerusalem longitudinal study. J Am Geriatr Soc


Lau KM, Parikh M, Harvey DJ, Huang C‑J, Farias ST.

Early cognitively based functional limitations predict loss of

independence in instrumental activities of daily living in older

adults. J Int Neuropsychol Soc 2015;21:688‑98.

Lowthian J, Straney L, Brand C, Barker A, Smit P, Newnham H, et al. Predicting functional decline in older emergency

patients‑the Safe Elderly Emergency Discharge (SEED) project.

Age Ageing 2017;46:219‑25.

Wojtusiak J, Levy CR, Williams AE, Alemi F. Predicting

functional decline and recovery for residents in veterans affairs

nursing homes. Gerontologist 2015;56:42‑51.