Screening for frailty in older emergency department patients: the utility of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument

Fallon, Aoife; Kilbane, Lorna; Briggs, Robert; Dyer, Adam H.; Nabeel, Shamis; McElwaine, Paul; Collins, Rónán; Coughlan, Tara; O’Neill, Desmond; Ryan, Dan; Kennelly, Sean

doi:10.1093/qjmed/hcx242

Cited by 20 publications

(20 citation statements)

References 13 publications

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“…Fallon et al cited this concern to justify why their prospective cohort study failed to observe an association between frailty and mortality in ED patients, with frailty having been measured by a questionnaire and grip strength test. 27 Tucker et al sought to pilot test the feasibility of the gait speed test by ED nurses, and although the nurses agreed that "gait speed screening should be implemented in the ED as a standard of care for older patients," they managed to collect these data in only 21/35 patients. 28 Sirois et al attempted to circumvent the ED patients' acute physical limitations by asking them to self-rate their lower-extremity strength, energy, and weight ED = emergency department; GI = gastrointestinal; GU = genitourinary; MSK = musculoskeletal.…”

Section: Discussionmentioning

confidence: 99%

Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

Afilalo

Mottillo

Xue

et al. 2020

CJEM

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BackgroundA growing number of frail older adults are treated in the emergency department (ED) and discharged home. There is an unmet need to identify older adults that are predisposed to functional decline and repeat ED visits so as to target them with proactive interventions.MethodsA prospective cohort study was conducted in patients 75 years or older who were being discharged from the ED. The objective was to test the value of frailty screening tests, namely 5-meter gait speed and handgrip strength, to predict repeat ED visits at 1 and 6 months and functional decline at 1 month using multivariable logistic regression.ResultsAfter excluding 7 patients lost to follow-up, 150 patients were available for analysis. The mean age was 81.1 ± 4.9 years with 51% females, 13% arriving by ambulance, and 67% having at least two comorbid conditions. At ED discharge, 41% of patients were found to have slow gait speed, whereas 23% had weak handgrip strength. After adjustment, only slow gait speed was independently associated with functional decline at 1 month (odds ratio [OR] 1.39 per 0.1 meters/second decrement, 95% confidence interval [CI], 1.12 to 1.72) and repeat ED visits at 6 months (OR 1.20 per 0.1 meters/second decrement, 95% CI, 1.01 to 1.42).ConclusionsGait speed can be feasibly measured at the time of ED discharge to identify frail older adults at risk for early functional decline and subsequent return to the ED. Conversely, grip strength was not found to be associated with functional decline or ED visits.

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Section: Discussionmentioning

confidence: 99%

Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

Afilalo

Mottillo

Xue

et al. 2020

CJEM

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“…In summary, this study shows that older people who had contact with the GPC had a relevant problem with frailty. Previous studies on frailty of older persons in the emergency care usually focused on the setting of the emergency department (26)(27)(28)(29) or the general practitioners practice during daytime(30-33). Studies in the last group did not differentiate between regular, chronic and emergency primary healthcare.…”

Section: Discussion Principal Findingsmentioning

confidence: 99%

Older persons are more frail after an emergency care visit to the out-of-hours General Practitioner Cooperative in the Netherlands: a cross sectional descriptive TOPICS-MDS study

Bloemhoff¹,

Schoon²,

Smulders

et al. 2020

Preprint

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Background In the Netherlands community dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains often unobserved with the hazard of adverse health outcomes. The aim of this study was to provide insight in differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use.Methods A cross-sectional descriptive study design was based on data from the public data repository: The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n=32,149) was measured by co-morbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analysis. A random intercept model was utilized to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results Older persons with GPC contact were, compared to the reference group, more frail on the domain of co-morbidity (mean difference 0.52 ; 95% CI 0.47-0.57, p <0.0001), functional limitations (mean difference 0.53 ; 95% CI 0.46-0.60, p <0.0001), reported less emotional wellbeing (mean difference -4.10 ; 95% CI -4.59- -3.60, p <0.0001) and experienced less quality of life (mean difference -0.057 ; 95% CI -0.064- -0.050, p <0.0001). Moreover, older persons reported more often limited social function (OR 1.50, 95%CI 1.39-1.62, p <0.0001) and limited perceived health (OR 1.50, 95%CI 1.39-1.62, p <0.0001). Finally, older persons with GPC contact more often used home care (OR 1.37, 95%CI 1.28-1.47, p <0.0001) or were more often admitted to the hospital (OR 2.88, 95%CI 2.71-3.06, p <0.0001). Conclusions Older persons with out-of-hours GPC contact for an emergency care visit were significantly more frail on all domains, more likely to use home care or to be admitted to the hospital, compared to the reference group. Potentially frail older persons seem to require adequate identification of frailty, and support (e.g. advance care planning) before and after a contact with the out-of-hours GPC.

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“…In recent years, several instruments for the screening of frailty in older persons have been developed. Many of these instruments focus on the identification of physical, functional or cognitive aspects of frailty [ 34 , 53 ], such as the ISAR (Identification of Seniors at Risk) [ 32 ], the SHARE-FI (Survey of Health, Ageing and Retirement in Europe Frailty Instrument) [ 31 ], and the APOP screener [ 54 ], while other instruments are focused on a multi-dimensional screening of frailty in the elderly such as the Groningen Frailty Indicator [ 55 ], the Frail-VIG [ 53 ] and Easy-Care TOS [ 33 , 56 ]. Based on our study results, we recommend developing building blocks and tools for a multi-dimensional screening of frailty in emergency primary healthcare settings such as the GPC.…”

Section: Discussionmentioning

confidence: 99%

“…In summary, this study shows that older people who had contact with the GPC had a relevant problem with frailty. Previous studies on frailty of older persons receiving emergency care have usually focused on the setting of the emergency department [29][30][31][32] or the general practitioners' practice during daytime hours [33][34][35][36]. Studies in the last group did not differentiate between regular, chronic and emergency primary healthcare.…”

Section: Principal Findingsmentioning

confidence: 99%

Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study

Bloemhoff¹,

Schoon

Smulders

et al. 2020

BMC Fam Pract

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Background: In the Netherlands, community-dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains an often unobserved hazard with adverse health outcomes. The aim of this study was to provide insight into differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use. Methods: A cross-sectional descriptive study design was based on data from the public data repository of The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n = 32,149) was measured by comorbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analyses. A random intercept model was utilised to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results: Compared to the reference group, older persons with GPC contact were frailer in the domain of comorbidity (mean difference 0.52; 95% CI 0.47-0.57, p < 0.0001) and functional limitations (mean difference 0.53; 95% CI 0.46-0.60, p < 0.0001), and they reported less emotional wellbeing (mean difference − 4.10; 95% CI-4.59-3.60, p < 0.0001) and experienced a lower quality of life (mean difference − 0.057; 95% CI-0.064-0.050, p < 0.0001). Moreover, older persons more often reported limited social functioning (OR = 1.50; 95% CI 1.39-1.62, p < 0.0001) and limited perceived health (OR = 1.50, 95% CI 1.39-1.62, p < 0.0001). Finally, older persons with GPC contact more often used home care (OR = 1.37; 95% CI 1.28-1.47, p < 0.0001) or were more often admitted to the hospital (OR = 2.88; 95% CI 2.71-3.06, p < 0.0001).

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Screening for frailty in older emergency department patients: the utility of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument

Abstract: Almost half of the sample cohort was frail. Older age was a better predictor of adverse outcomes than frailty as categorized by the SHARE-FI. SHARE-FI has limited predictability when used as a frailty screening instrument in the ED.

Cited by 20 publications

References 13 publications

Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

Older persons are more frail after an emergency care visit to the out-of-hours General Practitioner Cooperative in the Netherlands: a cross sectional descriptive TOPICS-MDS study

Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study

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