Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

Abstract

ObjectiveGiven the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years.MethodsA search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer‐reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting.ResultsA total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full‐text review. Twenty‐eight were excluded for not meeting inclusion criteria, leaving 39 full‐text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision‐making phases of the ED care trajectory, with varying reports of usefulness for clinical decision‐making.ConclusionThe literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front‐line medical professionals on patient‐oriented outcomes, and to ensure these initiatives are acceptable for patients.

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

“…The geriatric frequently required medium-high care intensity and higher triage codes. Therefore, our study is in line with the literature and underscores the finding that age itself does not cause crowding; however, age is a factor related to frailty in compromised patients [89][90][91][92]. The general fragility of geriatric patients increases crowding and wait times.…”

Elective Surgery Trends and Outcomes of Nonagenarians and Centenarians in Otolaryngology–Head and Neck Surgery: A NSQIP Study

“…Instead, frailty, as quantified by the 5-point modified frailty index, may be a better predictor of postoperative outcomes and a more suitable metric for surgeons to decide whether or not to operate on very old patients. [18][19][20][21][22] By assessing frailty preoperatively, surgeons may be able to better stratify risk, tailor perioperative care, and help patients make informed decisions about surgery, leading to improved patient outcomes.…”