Identification of older adults with frailty in the Emergency Department using a frailty index: results from a multinational study

• Published in: Age and ageing 2018-03, Vol.47 (2), p.242-248
• Main Authors: Brousseau, Audrey-Anne, Dent, Elsa, Hubbard, Ruth, Melady, Don, Émond, Marcel, Mercier, Éric, Costa, Andrew P
• Format: Article
• Language: English
• Subjects: Aged; Cohort analysis; Company business management; Critical incidents; Discharge; Elderly; Emergency service; Emergency services; Frail elderly; Frailty; Geriatric assessment; Geriatrics; Health aspects; Health risk assessment; Hospital emergency services; Hospitalization; Hospitals; Long term health care; Management; Older people; Patient admissions; Risk assessment
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afx168

Abstract Objective frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged ≥75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. Results there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34−1.52]); death at 28 days (OR = 1.55 [1.38–1.73]); prolonged hospital stay (OR = 1.37 [1.22–1.54]); discharge to long-term care (OR = 1.30 [1.16−1.47]); and need for Comprehensive geriatric Assessment (OR = 1.51 [1.41–1.60]). The multinational cohort showed similar associations. Conclusion the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.