Frailty Assessment in the Emergency Department

• Published in: The Journal of emergency medicine 2013-08, Vol.45 (2), p.291-298
• Main Authors: Stiffler, Kirk A., MD, MPH, Finley, Allison, MD, Midha, Sonia, BS, Wilber, Scott T., MD, MPH
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Cross-Sectional Studies; Emergency; Emergency Service, Hospital; Feasibility Studies; Female; Frail Elderly; gait speed; Geriatric Assessment - methods; geriatrics; Humans; Male; Muscle Strength; muscle weakness; Self Report; Sensitivity and Specificity; Surveys and Questionnaires; Walking
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2012.11.047

Abstract Background Frailty (defined as weakness, slowness, weight loss, exhaustion, and physical inactivity) is characterized by increased vulnerability to stressors. Frail older patients are at increased risk of Emergency Department (ED) visits, hospitalization, disability, and death. Objectives Our aims were to determine the prevalence of frailty (and assess the feasibility of measuring frailty) in older ED patients. We also assessed the correlation of self-reported speed and weakness to measured values and the association between frailty and function. Methods We performed a study of discharged ED patients aged ≥ 65 years. We used Fried’s frailty definition and a validated activities-of-daily-living (ADL) scale. We measured self-reported and objective weakness and slowness. Data were reported as means and proportions with 95% confidence interval (CI); associations were measured using 95% CI for the differences. Ninety patients provided a 95% CI of ± 10%. Results The mean age of the 90 patients was 76 ± 6.4 SD years; 51% were male. Mean assessment time was 7.4 min (95% CI 6.9–7.9). Twenty percent of patients were frail (18/90, 95% CI 12–30%). Self-report was 18% sensitive and 90% specific for objective weakness; self-report was 42% sensitive and 86% specific for objective slowness. Frail and weak patients were more likely dependent in one or more ADLs (26% difference, 95% CI 1–51% and 20% difference, 95% CI 1–41%, respectively). Conclusions Frailty is common in discharged older ED patients. Self-reported weakness and slowness are poor predictors of their objective counterparts. Frailty was associated with ADL dependence. These two domains may be reliable markers for elderly ED patients at high risk for adverse outcomes.