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Background The Indicator of Relative Need (IoRN) tool is widely used by health and social care services in Scotland to record client dependency. Services wishing to use the IoRN to predict future care needs and risk of events such as death, hospitalization and care home admission require external validation of the tool for these purposes. Using linked health and social care data provides a novel method of externally validating the IoRN for these uses.
Methods Clients aged 65 and over who underwent IoRN assessment by Dundee Social Work department over a 5 year period (2008-2012) were included in this analysis. Routinely collected health and social care data from NHS Tayside and Dundee Social work department were probabilistically linked via the Health Informatics Centre at the University of Dundee. Cox regression analysis was used to test the association between categories of dependency on the IoRN score and risk of death, hospitalisation and care home admission. Analyses were adjusted for age, sex number and length of stays in hospital.
Results 1732 individuals were included in the analysis; mean age 81 years. 1214 (70%) were female and 144 (8%) died during a mean follow-up period of 2.5 years. The adjusted hazard ratio for death in the most dependent category compared to the least dependent category was 5.9 (95% CI, 2.0 to 17.0); for care home admission ratio was 7.2 (95% CI, 4.4 to 12.0) and for hospital admission 1.1 (95% CI, 0.5 to 2.6). The mean number of allocated hours of care 6 months after assessment was higher in the most dependent group compared to the least dependent group (5.6 hrs. vs 1.4 hrs., p = 0.005)
Conclusion IoRN category is associated with risk of death, care home admission and future need for care, but does not provide additional information to predict future hospital admission.