Table 3.

Psychometric properties of tools used since Sutton et al¹

Functional decline assessment tools	Author, date, and critical appraisal score	Population group and country	Psychometric properties
			Predictive validity	Reliability	Generalizability	Clinical utility
HARP	de Saint-Hubert et al25 CASP score: 7/10	98 participants, ≥75 years, at a tertiary care hospital in Belgium	AUC 0.68 (95% CI: 0.57–0.77)	Findings similar to other studies	Findings similar to other studies with larger cohorts.	Not stated
	Hoogerduijn et al22 CASP score: 8/10	177 older participants in a 1024 bed university teaching hospital in the Netherlands	Low, intermediate, and high risk. Sensitivity was 61%, 40%, and 21%, respectively. Specificity was 68%, 81%, and 89%, respectively. AUC was 0.65, 0.60, and 0.56, respectively.	Not stated	Not stated	Identifying patients at risk for functional decline is a first step in prevention, followed by geriatric assessment and targeted interventions. Studying the validity of existing instruments is necessary before implementation in clinical practice.
SHERPA	de Saint-Hubert et al25 CASP score: 7/10	98 participants, ≥75 years, at a tertiary care hospital in Belgium	AUC 0.73 (95% CI: 0.63–0.82) at a cutoff of 3.5 Sensitivity 98% Negative LR: 0.07	Findings similar to other studies	Findings similar to other studies with larger cohorts.	Not stated
ISAR	Braes et al11 CASP score: 8/10	Older Dutch-speaking adults, hospitalized following an emergency department presentation in a 1470 bed academic hospital in Belgium	All measures at 90 days: Sensitivity: 0.74 (95% CI: 0.59–0.85) NPV 83 Specificity: 0.36 (95% CI: 0.32–0.40) PPV 25 Accuracy 45%	Not stated	Not stated	Increases awareness regarding the basic geriatric attention points.
	de Saint-Hubert et al25 CASP score: 7/10	98 participants, ≥75 years, at a tertiary care hospital in Belgium	AUC: 0.549	Findings similar to other studies	Findings similar to other studies with larger cohorts.	Not stated
	Graf et al26 CASP score: 10/10	An historical cohort of 345 patients’ ≥75 years, assessed by a geriatric team at the Geneva university hospital in Switzerland	All measures at 6 months AUC 0.660 Sensitivity 91.8% Specificity 28.6% PPV 55.5% NPV 78.1%	Not stated	Among ED-patients ≥ 75 years, the ISAR predicted unplanned readmission with moderate accuracy, due to low specificity.	The ISAR seems to be easier to routinely use in the ED.
	Hoogerduijn et al22 CASP score: 8/10	177 older participants in a 1024 bed university teaching hospital in the Netherlands.	AUC 0.67 Sensitivity 93% Specificity 39%	Not stated	Not stated	Identifying patients at risk for functional decline is a first step in prevention, followed by geriatric assessment and targeted interventions. Studying the validity of existing instruments is necessary before implementation in clinical practice.
	Salvi et al23 CASP score: 9/10	200 older patients, presenting at the emergency department of a tertiary hospital in Italy	Specificity 46.5% Sensitivity 77.5%	Not Stated	Was an effective test for frailty in the Italian population as well as the Canadian population the tool was originally trialled on.	Is easily administered by a nurse post admission with no further training required or appreciable time taken.
	Salvi et al24 CASP score: 9/10	All patients aged ≥ 75, assessed by the geriatric team during a 3-year period (2007–2009) in the emergency department of two urban hospitals in Italy, and discharged home	Cutoff of 3 AUC 0.92 Sensitivity 0.79 (95% CI: 0.71–0.86) Specificity 0.93 (95% CI: 0.84–0.97)	Valid and reliable	Findings similar to previous larger studies, but conducted in two EDs of a large Italian city. Recommend caution in generalizing results.	May be administered by a trained nurse just after triage, without any further workload for the ED staff.
TRST	Braes et al11 CASP score: 8/10	Older Dutch-speaking adults, hospitalized following an emergency department presentation in a 1470 bed academic hospital in Belgium	All measures at 90 days: Sensitivity: 0.78 (95% CI: 0.63–0.89) NPV 89 Specificity: 0.50 (95% CI: 0.46–0.53) PPV 31 Accuracy 56%	Not stated	Not stated	Increases awareness regarding the basic geriatric attention points.
	Graf et al26 CASP score: 10/10	An historical cohort of 345 patients >75 years, assessed by a geriatric team at the Geneva University hospital in Switzerland	All measures at 6 months AUC 0.640 Sensitivity 88.8% Specificity 27.4% PPV 54.3% NPV 71.6%	Not stated	Among ED patients ≥ 75 years, the TRST predicted unplanned readmission with moderate accuracy, due to low specificity.	The “professional recommendation” item of the TRST tool is subjective and particularly difficult to estimate in clinical use.
Inouye instrument	No articles using/testing this instrument were found in this systematic review.

Abbreviations: AUC, area under the curve; CASP, Critical Appraisal Skills Programme; CI, confidence interval; ED, emergency department; HARP, Hospital Admission Risk Profile; ISAR, Identification of Seniors At Risk; LR, likelihood ratio; NPV, negative predictive value; PPV, postive predictive value; TRST, Triage Risk Screening Tool.