147 Frailty in an Emergency Department: Predictors and Point Prevalence of Frailty and Pre-Frailty in an Irish Cohort

Small, Cliona; Spooner, Lynn; Costello, Maria; Flannery, Antoinette; O’Reilly, Liam; Heffernan, Laura; Mannion, Edel; Sheil, Orla; Bruen, Sinéad; Burke, Pauline; Kyne, Nora; McMahon, Mary; Molloy, D. William; Maughan, A.D.; Joyce, Alma; Hanrahan, Helen; Stallard, Georgina; O’Donnell, John J.; Ó’Caoimh, Rónán

doi:10.1093/ageing/afw159.28

Cited by 5 publications

(3 citation statements)

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“…That systematic review identified much broader variation of prevalence (5–93% older people across different ward settings) than that among older emergency care users here (26–51% across sixty-two sites). National frailty prevalence observed here was similar to previous single-center emergency care reports from Ireland (42% vs 29–60% [ 23 , 24 ]) and England (42% vs 55% [ 8 ]), but lower in The Netherlands (26% vs 44% [ 25 ]) indicating possible site selection bias.…”

Section: Discussionsupporting

confidence: 88%

Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study

Coats,

Conroy,

de Groot

et al. 2024

Eur Geriatr Med

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Introduction Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. Methods This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). Results Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. Conclusion 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.

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Section: Discussionsupporting

confidence: 88%

Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study

Coats,

Conroy,

de Groot

et al. 2024

Eur Geriatr Med

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“…Frailty is increasingly recognised as an emerging public health priority [ 12 ] and is associated with increased hospital length of stay (LOS), mortality, and healthcare costs [ 13 , 14 , 15 ]. Although frail older adults represent only approximately 10% of those attending ED [ 16 ], they represent the majority (60%) of older attendees [ 17 ] and have higher admission rates (ED conversion defined by the number of admissions as a proportion of attendees) [ 18 ]. The changing age profile of ED attendees is itself a public health concern.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Risk Instrument for Screening in the Community (RISC) among Older Adults in the Emergency Department

Ó’Caoimh

2023

IJERPH

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Although several short-risk-prediction instruments are used in the emergency department (ED), there remains insufficient evidence to guide healthcare professionals on their use. The Risk Instrument for Screening in the Community (RISC) is an established screen comprising three Likert scales examining the risk of three adverse outcomes among community-dwelling older adults at one-year: institutionalisation, hospitalisation, and death, which are scored from one (rare/minimal) to five (certain/extreme) and combined into an Overall RISC score. In the present study, the RISC was externally validated by comparing it with different frailty screens to predict risk of hospitalisation (30-day readmission), prolonged length of stay (LOS), one-year mortality, and institutionalisation among 193 consecutive patients aged ≥70 attending a large university hospital ED in Western Ireland, assessed for frailty, determined by comprehensive geriatric assessment. The median LOS was 8 ± 9 days; 20% were re-admitted <30 days; 13.5% were institutionalised; 17% had died; and 60% (116/193) were frail. Based on the area under the ROC curve scores (AUC), the Overall RISC score had the greatest diagnostic accuracy for predicting one-year mortality and institutionalisation: AUC 0.77 (95% CI: 0.68–0.87) and 0.73 (95% CI: 0.64–0.82), respectively. None of the instruments were accurate in predicting 30-day readmission (AUC all <0.70). The Overall RISC score had good accuracy for identifying frailty (AUC 0.84). These results indicate that the RISC is an accurate risk-prediction instrument and frailty measure in the ED.

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“…The number of older people attending ED is high [11], and as the population ages, this is expected to increase. There is a pressing need to identify the goals of care on presentation to hospital to enhance delivery of integrated, symptom-focused supportive care to frail older people [12,13].…”

Section: Introductionmentioning

confidence: 99%

Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department

Gaffney

Jonsson

Judge

et al. 2022

IJERPH

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The “surprise question” (SQ) predicts the need for palliative care. Its predictive validity for adverse healthcare outcomes and its association with frailty among older people attending the emergency department (ED) are unknown. We conducted a secondary analysis of a prospective study of consecutive patients aged ≥70 attending a university hospital’s ED. The SQ was scored by doctors before an independent comprehensive geriatric assessment (CGA). Outcomes included length of stay (LOS), frailty determined by CGA and one-year mortality. The SQ was available for 191 patients, whose median age was 79 ± 9. In all, 56/191 (29%) screened SQ positive. SQ positive patients were frailer; the median clinical frailty score was 6/9 (compared to 4/9, p < 0.001); they had longer LOS (p = 0.008); and they had higher mortality (p < 0.001). Being SQ positive was associated with 2.6 times greater odds of admission and 8.9 times odds of frailty. After adjustment for age, sex, frailty, co-morbidity and presenting complaint, patients who were SQ positive had significantly reduced survival times (hazard ratio 5.6; 95% CI: 1.39–22.3, p = 0.015). Almost one-third of older patients attending ED were identified as SQ positive. These were frailer and more likely to be admitted, have reduced survival times and have prolonged LOS. The SQ is useful to quickly stratify older patients likely to experience poor outcomes in ED.

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147 Frailty in an Emergency Department: Predictors and Point Prevalence of Frailty and Pre-Frailty in an Irish Cohort

Cited by 5 publications

References 0 publications

Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study

Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study

Validation of the Risk Instrument for Screening in the Community (RISC) among Older Adults in the Emergency Department

Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department

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