Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

A Probability of Repeated Admission (Pra) score greater than 0.5 predicts hospital admission for older adults living in the community

Wallace E, Hinchey T, Borislaw D, et al. A systematic review of the probability of repeated admission score in community-dwelling adults. J Am Geriat Soc. 2013;61:357-64

Review question

How useful is the Probability of Repeated Admission score to predict hospital admission of older adults living in the community?


Hospital admissions are major health events in a person’s life and also a large share of health care expenses. Early identification of people with high risk for future admissions will help to prepare better for care.

The Probability of Repeated Admission (or Pra) score identifies older adults who are more likely to need hospital admission.

Pra scores go from 0 to 1. A score of 0.5 means a 50% likelihood of 2 or more admissions within the following 4-year period.

The risk factors for repeated admission are 8: older age, male sex, poor self-rated general health, unavailability of an informal caregiver, having ever had heart disease, and having had, during the previous year, a hospital admission, more than 6 doctor visits, or diabetes.

How the review was done

This summary is based on a review of 9 studies on the usefulness of the Pra score to predict hospital admissions. The period included was 1990-2012.

Studies included 36,140 people 65 and older.

The primary outcome of all the studies was hospital admissions. Secondary outcomes included mortality, hospital days, decline in function, other service use, and costs.

What the researchers found

Older adults classified as high risk were more likely to have a hospital admission in the following year. They also had more admissions later.

Pra scores clearly distinguished those who had been admitted to the hospital from those who had not.

Secondary outcomes (mortality, hospital days, decline in function, other health service use, and costs) were difficult to compare across studies. But the Pra score could also predict who would have higher future health care use and costs.


The Pra score is useful to identify older adults living in the community with a high risk of hospital admission.

Probability of repeated admission assessment

Target group

Older adults living in the community.

Primary outcome

Prediction of hospital admissions and need for special services.

Pra scores

Between 0 and 1.

Risk levels

High risk if value greater than 0.5.


Very useful for people at high risk.

Secondary outcomes

Mortality, hospital days, decline in function, other health service use, costs.


Difficult to compare across studies.



Risk factors
Aspects making a condition more likely.

Related Web Resources

  • Dementia in long-term care

    Canadian Institute for Health Information
    Older adults with dementia may need to move into long-term care homes if they can no longer stay at home. These people have higher risk of getting physically restrained or given antipsychotic medication. Changes to policy and education have made these things happen less often.
  • Treating pressure ulcers: New evidence, continued uncertainty

    Evidently Cochrane
    Gauze dressings should not be used to treat pressure ulcers (bed sores). Other options include alginate dressings, hydrogel dressings, and negative pressure wound therapy. More evidence is needed about which options are best to improve pain and reduce complications. Research should measure outcomes that matter to patients and carers as well as health professionals.
  • Patient education: Delirium (Beyond the Basics)

    UpToDate - patient information
    Delirium is the result of brain changes that lead to confusion, lack of focus and memory problems. There is no specific treatment for delirium - it is best to avoid risks, treat underlying illnesses and receive supportive care. Sedatives and physical restraints should be avoided.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Register for free access to all Professional content