212Screening Frailty in the Emergency Department: The Utility of the SHARE-FI in Predicting Outcomes in a Cohort of Older Patients

Abstract

Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for high risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) [1] was developed for use in the community but has been shown to be useful in the emergency department (ED). Objective: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts. Methods: Prospective cohort study was carried out with pre-specified convenience sampling of those aged.70 years presenting to ED on a 24/7 basis, from January-August 2014. Patient characteristics were recorded using the symphony® electronic data system; SHARE-FI assessed frailty. Cognition, delirium and six and twelve month outcomes were reviewed. Binary logistic regression was used to estimate odds ratios for covariates. Results: Age predicted mortality (OR2.34, 95% CI1.30.4.21, p = 0.004) and the composite outcome of 'alive and at home' at 12 months (OR0.49, 95% CI0.23.0.83, p = 0.009). Dementia (OR0.24, p = 0.005) and polypharmacy (OR0.37, 95% CI0.16.0.87, p = 0.022) were predictive of being alive and at home at twelve months. Frailty was not associated with a significant difference in mortality rates (OR0.89, 95% CI0.58.1.38, p = 0.614) or being alive and at home at 12 months (OR1.07, 95% CI0.72.1.57, p = 0.745). Conclusions: This study suggests SHARE-FI was an inappropriate screening instrument in the ED. It may be of greater use to treat all older patients as being at risk of adverse outcomes. New screening tools to assess older patients presenting to hospital are required.