Self-assessment of functional status in older emergency department patients: a cross-over randomized pilot trial

To assess the inter-rater reliability and feasibility of the self-assessed Older Americans Resources and Services scale compared to its administration by a research assistant in older Emergency Department (ED) patients.

This is a planned sub-analysis of a single-center randomized cross-over pilot study. A convenience sample of ED patients aged ≥ 65 was constituted at the CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus) between 2018/05 and 2018/07. Research assistants assessed participants' functional status using the Older Americans Resources and Services scale and patients self-assessed using a modified Older Americans Resources and Services scale. Test administration order was randomized. The main outcome, inter-rater reliability, was measured using intraclass correlation (ICC). Feasibility was measured using self-assessment completion rate.

67 patients were included and 60 completed self-assessment. Mean age was 74.4 ± 7.6 and 34 (56.7%) participants were women. Mean research assistant-assessed Older Americans Resources and Services scale score was 25.1 ± 3.3, while mean self-assessed Older Americans Resources and Services scale score was 26.4 ± 2.5 [ICC: 0.8 (95% CI: 0.7-0.9)]. Mean activities of daily living scores were 12.5 ± 1.8 for research assistant assessment and 13.5 ± 0.9 for self-assessment [ICC: 0.6 (95% CI: 0.4-0.7)]. Mean instrumental activities of daily living scores were 12.6 ± 1.8 and 12.9 ± 1.8 for research assistant assessment and self-assessment, respectively [ICC: 0.9 (95% CI: 0.8-0.9)].

Our results indicate that self-assessment of functional status by older ED patients is feasible, and good-to-moderate inter-rater reliability results were obtained. A self-assessed score may identify patients in need of further geriatric/functional assessment who may otherwise have been left unscreened.