Review article: Roles of activities of daily living and frailty assessments for residents of residential aged care services in emergency department transfers: A scoping review

Abstract

Residents from residential aged care services (RACS) (i.e. nursing homes) many of whom are frail or disabled, are frequently transferred to ED for treatment of acute episodes of illness or injury. This review scoped the research related to the ways in which frailty or activities of daily living (ADL) measures are used for clinical purposes, either prior to the transfer of patients to ED or in ED themselves. A search for original studies up to June 2021 that included participants aged 65 years or over was conducted across four databases. Abstracts were first reviewed, leading to full text screening and article selection. Thirty‐four studies were included in the scoping review. Most of the ADL and frailty assessments were conducted in residential aged care settings. In seven studies, ADL or frailty assessments in the aged care setting contributed to reduced transfer rates to ED. No results were found that associated the assessment of ADL or frailty with decisions related to treatment in the ED. A single ED study involved specialist emergency nursing in an ED as an intervention which included frailty assessment and led to decreased hospitalisation. This scoping review confirms an opportunity for further research into the ways frailty and ADL assessments are used for decision making in relation to the transfer of frail older people to ED, including how these assessments influence their treatment.

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

“…40 A prospective cohort study in Ireland similarly found that there was no difference in 1-year mortality between ED patients classified as frail and those who were not. 41 Smyth et al 42 conducted a scoping review on how frailty and ADL impact decisions to transfer patients from nursing homes to the ED and were unable to find any study examining how ADL or frailty were associated with decisions to treat patients while in the ED, whereas several studies in the review found that ADL/frailty were associated with reduced transfers to ED and hospitalization.…”