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

Abstract

Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) frailty measure, developed for use in the community, has also been used in the emergency department (ED). Aim: 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. Design: Patient characteristics were recorded using symphonyVR electronic data systems. SHARE-FI assessed frailty. Cognition, delirium and 6 and 12 months outcomes were reviewed. Methods: A prospective cohort study was completed of those aged ≥70 presenting to ED over 24 h, 7 days a week. Results: Almost half of 198 participants (46.7%, 93/198) were classified as frail, but this was not associated with a significant difference in mortality rates (OR 0.89, 95% CI 0.58-1.38, P=0.614) or being alive at home at 12 months (OR 1.07, 95% CI 0.72-1.57, P=0.745). Older patients were more likely to die (OR 2.34, 95% CI 1.30-4.21, P=0.004) and less likely to be alive at home at 12 months (OR 0.49, 95% CI 0.23-0.83, P=0.009). Patients with dementia (OR 0.24, P=0.005) and on ≥5 medications (OR 0.37, 95% CI 0.16-0.87, P=0.022) had a lower likelihood of being alive at home at 12 months. Conclusions: 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.