Highlights
- •Frail elders in need of further geriatric assessment should be identified in the ED.
- •Frailty Screening predicts risk of mortality and admission to hospital/nursing home.
- •Increased risk of 30 day ED revisit is not predicted by frailty screening.
- •To assess validity of frailty screening in EDs randomized clinical trials are needed.
Abstract
Background
Several frailty rating scales have been developed to detect and screen for the level
of frailty. It is uncertain what diagnostic value screening of frailty level have
in the emergency department.
Aim
To assess the accuracy of the screening tools used in the emergency department to
detect frailty in patients ≥ 65 years by their ability to identify the risk of adverse outcomes.
Methods
An extensive medical literature search of Embase and PubMed was conducted, to identify
studies using frailty screening scales in the emergency department. Data was subsequently
extracted and evaluated from the results of the included studies.
Results
Four studies met the exact inclusion criteria. Four different frailty screening scales:
Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk
and The Study of Osteoporotic Fracture frailty index used in the emergency department
were described and compared. Predictive values for various outcomes are represented
and discussed.
Conclusions
The results suggest that frailty successfully predicts increased risk of hospitalization,
nursing home admission, mortality and prolonged length of stay after an initial emergency
department visit. Frailty does however not predict increased risk of 30 day emergency department revisit. Further research highlighting the value of screening
for frailty level in elderly emergency department patients is needed.
Learning points
Although frail elders in need of further geriatric assessment should be identified
as soon as possible, this systematic review only identified four cohort studies of
frailty assessment in emergency departments.
Although frailty screening appeared to predict the risk of mortality and of admission
to hospital/nursing home, these four studies did not show that it could predict return
visits to emergency departments within 30 days.
Randomized clinical trials of frailty screening tools compared to usual care or other
methods of assessment are clearly needed.
Keywords
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Article info
Publication history
Published online: October 04, 2017
Accepted:
September 27,
2017
Received in revised form:
September 26,
2017
Received:
September 10,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
