The Clinical Frailty Scale and Health Services Use for Older Adults in the Emergency Department

Serina, Peter; Lo, Alexander X.; Kocherginsky, Masha; Gray, Elizabeth; Lindquist, Lee A.; Post, Lori A.; Heinemann, Allen W.; Cruz, Daniel S.; Dresden, Scott M.

doi:10.1111/jgs.16937

Cited by 17 publications

(29 citation statements)

References 12 publications

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“…Most studies that assessed the effect of frailty on COVID‐19 mortality have been completed in Europe, particularly in the United Kingdom, 15‐17,43‐45 encouraged by the National Institute of Clinical Excellence (NICE) recommendation for using the CFS to guide the care of older adults hospitalized with COVID‐19 33 . In these studies, the prevalence of frailty ranged between 30% and 70%, similar to what we observed in patients over 65 (36%) and what was reported in Americans over 65 admitted to the hospital from the emergency department (36%) 46 . Although the CFS was not a strong predictor of mortality across all studies, 16,43 those with larger sample sizes and enough power to adjust for potential confounders were able to find an association between CFS‐defined frailty and short‐term mortality, 13,15,44 an assumption supported by the results from our sample based on a diverse population living in the epicenter of the pandemic in a low‐to‐middle‐income country.…”

Section: Discussionsupporting

confidence: 88%

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Aliberti

Szlejf

Avelino‐Silva

et al. 2021

J American Geriatrics Society

105

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Background: Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID-19) prognosis remains unclear.Objectives: To investigate the association between frailty and mortality over 6 months in middle-aged and older patients hospitalized with COVID-19 and the association between acute morbidity severity and mortality across frailty strata.Design: Observational cohort study. Setting: Large academic medical center in Brazil.Participants: A total of 1830 patients aged ≥50 years hospitalized with COVID-19 (March-July 2020).Measurements: We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7)(8)(9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox A complete list of investigators in the COVID HCFMUSP Study Group is provided in Data S1.

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Section: Discussionsupporting

confidence: 88%

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Aliberti

Szlejf

Avelino‐Silva

et al. 2021

J American Geriatrics Society

105

View full text Add to dashboard Cite

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“…44 Notably, there is currently debate about the best frailty tool 45 and, similar to falls, selecting tools that are feasible and valid for the ED population is an active area of investigation. 42,46 Table 2 includes examples of tools that may be appropriate, but investigators should reference the most recent literature in consultation with content experts to select the optimal approach for their studies. Other geriatric syndromes exist that we do not fully describe here, and geriatric syndrome measurement is complex and needs further study.…”

Section: Considering the Importance Of Geriatric Syndromesmentioning

confidence: 99%

“…Multiple scoring systems for frailty have been successfully used in the ED setting with good prediction of subsequent complications 44 . Notably, there is currently debate about the best frailty tool 45 and, similar to falls, selecting tools that are feasible and valid for the ED population is an active area of investigation 42,46 . Table 2 includes examples of tools that may be appropriate, but investigators should reference the most recent literature in consultation with content experts to select the optimal approach for their studies.…”

Section: Strategies For Inclusion Of Older Adults In Emergency Care R...mentioning

confidence: 99%

Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal

Hunold

Goldberg

Caterino

et al. 2021

Academic Emergency Medicine

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There are over 23 million emergency department (ED) visits by older adults (aged 65 years and older) annually 1 and this number is expected to grow because of longer life spans, the aging of baby boomers, 2,3 and the fact that older adults are increasingly seeking care in the ED rather than other settings. 3 In fact, older adults are expected to account for as much as one-third of ED visits by 2030. 4 Medical research across all fields has historically excluded older adults. [5][6][7][8] Of trials published between 1965 and 2015, 33% had arbitrary upper age limits, and 67% reported on subjects younger than those typically afflicted by the disease under study. 7 Older adults can also be systematically excluded without an explicit age

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“…Frailty, as measured by the Clinical Frailty Scale (CFS) 16 has been validated for use in several ED settings, 17‐19 and in other medical specialties, 20‐23 and is one of the most commonly used frailty measures. The popularity of the CFS in acute settings is likely due to its practical applicability in routine clinical care 24‐26 .…”

Section: Introductionmentioning

confidence: 99%

“…11 Hence, this could contribute to a shift towards an integrated, patient-centric approach that aligns with the vision of personalized medicine and geriatricized emergency care. [12][13][14][15] Frailty, as measured by the Clinical Frailty Scale (CFS) 16 has been validated for use in several ED settings, [17][18][19] and in other medical specialties, [20][21][22][23] and is one of the most commonly used frailty measures. The popularity of the CFS in acute settings is likely due to its practical applicability in routine clinical care.…”

mentioning

confidence: 99%

The clinical frailty scale predicts 1‐year mortality in emergency department patients aged 65 years and older

Rueegg

Nissen

Brabrand

et al. 2022

Academic Emergency Medicine

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Frailty is a state of increased vulnerability for poor resolution of homeostasis after a stressor event, so that frail individuals are at risk for adverse health outcomes and prolonged convalescence. 1 In the emergency department (ED), triage acuity predicts the outcomes of ED length of stay, hospitalization, intensive care unit (ICU) admission, and mortality within 30 days, 2 but may be ill-suited for prediction of adverse outcomes beyond this time frame. In a large Danish study, for example, abnormal vital signs were strong risk factors for mortality within the first 2 days, but hereafter, the association declined with time from arrival most rapidly until day 7. 3 Longer term prognostication is likely more dependent on physiological reserve such as the degree of frailty rather than how ill or

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The Clinical Frailty Scale and Health Services Use for Older Adults in the Emergency Department

Cited by 17 publications

References 12 publications

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal

The clinical frailty scale predicts 1‐year mortality in emergency department patients aged 65 years and older

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