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Internal and Emergency Medicine
Published in: Internal and Emergency Medicine 8/2022

Open Access 21-07-2022 | Emergency Medicine | CE-Systematic reviews and meta-analysis

Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review

Authors: Christophe Alain Fehlmann, Christian Hans Nickel, Emily Cino, Zinnia Al-Najjar, Nigèle Langlois, Debra Eagles

Published in: Internal and Emergency Medicine | Issue 8/2022

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Abstract

Background

Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research.

Methods

We performed a systemic literature search to identify original research that used the CFS in emergency medicine. Several databases were searched from January 2005 to July 2021. Two independent reviewers completed screening, full text review and data abstraction, with a focus on study characteristics, CFS assessment (evaluators, timing and purpose), study outcomes and statistical methods.

Results

A total of 4818 unique citations were identified; 34 studies were included in the final analysis. Among them, 76% were published after 2018, mainly in Europe or North America (79%). Only two assessed CFS in the pre-hospital setting. The nine-point scale was used in 74% of the studies, and patient consent was required in 69% of them. The main reason to use CFS was as a main exposure (44%), a potential predictor (15%) or an outcome (15%). The most frequently studied outcomes were mortality and hospital admission.

Conclusion

The use of CFS in emergency medicine research is drastically increasing. However, the reporting is not optimal and should be more standardized. Studies evaluating the impact of frailty assessment in the ED are needed.
Appendix
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Literature
1.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762PubMedCrossRef
2.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 173(5):489–495CrossRef
3.
WHO Clinical Consortium on Health Ageing (2017) Geneva, Switzerland: World Health Organization
4.
Choutko-Joaquim S, Tacchini-Jacquier N, Pralong D’Alessio G, Verloo H (2019) Associations between frailty and delirium among older patients admitted to an emergency department. Dement Geriatr Cognitive Disord Extra 9(2):236–249CrossRef
5.
Salvi F, Morichi V, Grilli A, Lancioni L, Spazzafumo L, Polonara S et al (2012) Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging 16(4):313–318PubMedCrossRef
6.
Aprahamian I, Arico de Almeida GV, de Vasconcellos Romanin CF, Gomes Caldas T, Antunes Yoshitake NT, Bataglini L et al (2019) Frailty could predict death in older adults after admissionat emergency department? A 6-month prospective study from a middle-income country. J Nutr Health Aging 23(7):641–647PubMedCrossRef
7.
Giroux M, Sirois M-J, Boucher V, Daoust R, Gouin E, Pelletier M et al (2018) Frailty assessment to help predict patients at risk of delirium when consulting the emergency department. J Emerg Med 55(2):157–164PubMedCrossRef
8.
Kojima G, Iliffe S, Walters K (2018) Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing 47(2):193–200PubMedCrossRef
9.
Kojima G (2016) Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health 70(7):722–729PubMedCrossRef
10.
Crocker TF, Brown L, Clegg A, Farley K, Franklin M, Simpkins S et al (2019) Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res 28(8):2041–2056PubMedPubMedCentralCrossRef
11.
Dent E, Hoogendijk EO, Cardona-Morrell M, Hillman K (2016) Frailty in emergency departments. Lancet 387(10017):434PubMedCrossRef
12.
Eagles D, Ellis B, Melady D (2020) Frailty: a key concept to improve older person care. CJEM 22(5):624–625PubMedCrossRef
13.
Elliott A, Phelps K, Regen E, Conroy SP (2017) Identifying frailty in the emergency department-feasibility study. Age Ageing 46(5):840–845PubMedCrossRef
14.
Hogan DB, Maxwell CJ, Afilalo J, Arora RC, Bagshaw SM, Basran J et al (2017) A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Can Geriatr J 20(1):22–37PubMedPubMedCentralCrossRef
15.
Elliott A, Hull L, Conroy SP (2017) Frailty identification in the emergency department-a systematic review focusing on feasibility. Age ageing 46:509–513PubMedCrossRef
16.
17.
Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J et al (2018) What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 18(1):139PubMedPubMedCentralCrossRef
18.
van Dam CS, Hoogendijk EO, Mooijaart SP, Smulders YM, Vet RCW, Lucke JA et al (2021) A narrative review of frailty assessment in older patients at the emergency department. Eur J Emerg Med 28:266–276PubMedCrossRef
19.
Meldon SW, Mion LC, Palmer RM, Drew BL, Connor JT, Lewicki LJ et al (2003) A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med 10(3):224–232PubMedCrossRef
20.
21.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495PubMedPubMedCentralCrossRef
22.
Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S et al (2019) Which frailty scale for patients admitted via Emergency Department? Cohort Study Arch Gerontol Geriatr 80:104–114PubMedCrossRef
23.
24.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467–473PubMedCrossRef
25.
Joanna Briggs Institute (2015) The Joanna Briggs Institute reviewers’ manual 2015. Methodol JBI Scoping Rev Joanna Briggs Inst JB.
26.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156PubMedCrossRef
27.
Dendukuri N, McCusker J, Belzile E (2004) The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc 52(2):290–296PubMedCrossRef
28.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46PubMedCrossRef
29.
Covidence systematic review software [Internet]. Veritas Health Innovation. Available from  accessed on July 6 2022 www.​covidence.​org.
30.
Beland E, Nadeau A, Carmichael P-H, Boucher V, Voyer P, Pelletier M et al (2021) Predictors of delirium in older patients at the emergency department: a prospective multicentre derivation study. CJEM 23(3):330–336PubMedCrossRef
31.
Boucher V, Lamontagne M-E, Lee J, Carmichael P-H, Dery J, Emond M (2019) Acceptability of older patients’ self-assessment in the Emergency Department (ACCEPTED)—a randomised cross-over pilot trial. Age Ageing 48(6):875–880PubMedCrossRef
32.
Dresden SM, Platts-Mills TF, Kandasamy D, Walden L, Betz ME (2019) Patient versus physician perceptions of frailty: a comparison of Clinical Frailty Scale scores of older adults in the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med 26(9):1089–1092CrossRef
33.
Fernando SM, Guo KH, Lukasik M, Rochwerg B, Cook DJ, Kyeremanteng K et al (2020) Frailty and associated prognosis among older emergency department patients with suspected infection: a prospective, observational cohort study. CJEM 22(5):687–691PubMedCrossRef
34.
Hominick K, McLeod V, Rockwood K (2016) Characteristics of older adults admitted to hospital versus those discharged home, in emergency department patients referred to internal medicine. Can Geriatr J CGJ 19(1):9–14PubMedCrossRef
35.
Lee J, Sirois M-J, Moore L, Perry J, Daoust R, Griffith L et al (2015) Return to the ED and hospitalisation following minor injuries among older persons treated in the emergency department: predictors among independent seniors within 6 months. Age Ageing 44(4):624–629PubMedPubMedCentralCrossRef
36.
Lo AX, Heinemann AW, Gray E, Lindquist LA, Kocherginsky M, Post LA et al (2021) Inter-rater reliability of clinical frailty scores for older patients in the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med 28(1):110–113CrossRef
37.
Provencher V, Sirois M-J, Emond M, Perry JJ, Daoust R, Lee JS et al (2016) Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge. Health Qual Life Outcomes 14(101153626):40PubMedPubMedCentralCrossRef
38.
Provencher V, Sirois M-J, Ouellet M-C, Camden S, Neveu X, Allain-Boule N et al (2015) Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc 63(5):860–868PubMedCrossRef
39.
Pulok MH, Theou O, van der Valk AM, Rockwood K (2020) The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing 49(6):1071–1079PubMedPubMedCentralCrossRef
40.
Ringer T, Thompson C, McLeod S, Melady D (2020) Inter-rater agreement between self-rated and staff-rated Clinical Frailty Scale scores in older emergency department patients: a prospective observational study. Acad Emerg Med Off J Soc Acad Emerg Med 27(5):419–422CrossRef
41.
Serina P, Lo AX, Kocherginsky M, Gray E, Lindquist LA, Post LA et al (2021) The Clinical Frailty Scale and health services use for older adults in the emergency department. J Am Geriatr Soc 69(3):837–839PubMedCrossRef
42.
Sirois M-J, Griffith L, Perry J, Daoust R, Veillette N, Lee J et al (2017) Measuring frailty can help emergency departments identify independent seniors at risk of functional decline after minor injuries. J Gerontol A Biol Sci Med Sci 72(1):68–74PubMedCrossRef
43.
Tong T, Chignell M, Tierney MC, Sirois M-J, Goldstein J, mond M et al (2017) Technology profiles as proxies for measuring functional and frailty status. Procedia Comput Sci 111:77–86CrossRef
44.
Alakare J, Kemp K, Strandberg T, Castrén M, Jakovljević D, Tolonen J et al (2021) Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial. BMC Geriatr 21(1):1–11CrossRef
45.
Bernard P, Corcoran G, Kenna L, O’Brien C, Ward P, Howard W et al (2021) Is pathfinder a safe alternative to the emergency department for older patients? Obs Anal Age Ageing 50:1854–1858CrossRef
46.
Elliott A, Taub N, Banerjee J, Aijaz F, Jones W, Teece L et al (2021) Does the Clinical Frailty Scale at triage predict outcomes from emergency care for older people? Ann Emerg Med 77(6):620–627PubMedCrossRef
47.
Griffin A, O’Neill A, O’Connor M, Ryan D, Tierney A, Galvin R (2020) The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr 20(1):455PubMedPubMedCentralCrossRef
48.
49.
Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR et al (2020) Validation of the Clinical Frailty Scale for prediction of thirty-day mortality in the emergency department. Ann Emerg Med 76(3):291–300PubMedCrossRef
50.
Kemp K, Alakare J, Harjola V-P, Strandberg T, Tolonen J, Lehtonen L et al (2020) National early warning score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med 20(1):83PubMedPubMedCentralCrossRef
51.
McGrath J, Almeida P, Law R (2019) The Whittington frailty pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project. BMJ open quality 8(4):e000798PubMedPubMedCentralCrossRef
52.
O’Caoimh R, Costello M, Small C, Spooner L, Flannery A, O’Reilly L et al (2019) Comparison of frailty screening instruments in the emergency department. Int J Environ Res Pub Health. 16(19):3626CrossRef
53.
O’Shaughnessy I, Romero-Ortuno R, Edge L, Dillon A, Flynn S, Briggs R et al (2021) Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med 85(9003220):50–55PubMedCrossRef
54.
Shrier W, Dewar C, Parrella P, Hunt D, Hodgson LE (2020) Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage. Emerg Med J EMJ 38:868–873PubMedCrossRef
55.
Simon NR, Jauslin AS, Rueegg M, Twerenbold R, Lampart M, Osswald S et al (2021) Association of frailty with adverse outcomes in patients with suspected COVID-19 infection. J Clin Med 10(11):2472PubMedPubMedCentralCrossRef
56.
Cardona M, Lewis ET, Kristensen MR, Skjot-Arkil H, Ekmann AA, Nygaard HH et al (2018) Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at emergency departments: a prospective study. Eur Geriatr Med 9(6):891–901PubMedPubMedCentralCrossRef
57.
Ishikawa S, Miyagawa I, Kusanaga M, Abe T, Shiraishi A, Fujishima S et al (2021) Association of frailty on treatment outcomes among patients with suspected infection treated at emergency departments. Eur J Emerg Med Off J Eur Soc Emerg Med 28(4):285–291CrossRef
58.
Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S et al (2019) Which frailty scale for patients admitted via emergency department? A cohort study. Arch Gerontol Geriatr 80:104–114PubMedCrossRef
59.
Liu H, Shang N, Chhetri JK, Liu L, Guo W, Li P et al (2020) A frailty screening questionnaire (FSQ) to rapidly predict negative health outcomes of older adults in emergency care settings. J Nutr Health Aging 24(6):627–633PubMedCrossRef
60.
Clark S, Shaw C, Padayachee A, Howard S, Hay K, Frakking TT (2019) Frailty and hospital outcomes within a low socioeconomic population. QJM Mon J Assoc Phys 112(12):907–913
61.
Shen VW-C, Yang C, Lai L-L, Chen Y-J, Huang H-H, Tsai S-H et al (2021) Emergency department referral for hospice and palliative care differs among patients with different end-of-life trajectories: a retrospective cohort study. Int J Environ Res Pub Health 18(12):6286CrossRef
62.
Cardona M, O’Sullivan M, Lewis ET, Turner RM, Garden F, Alkhouri H et al (2019) Prospective validation of a checklist to predict short-term death in older patients after emergency department admission in Australia and Ireland. Acad Emerg Med Off J Soc Acad Emerg Med 26(6):610–620CrossRef
63.
64.
Tu JV, Willison DJ, Silver FL, Fang J, Richards JA, Laupacis A et al (2004) Impracticability of informed consent in the registry of the Canadian Stroke Network. N Engl J Med 350(14):1414–1421PubMedCrossRef
65.
66.
Ruske J, Sharma G, Makie K, He K, Ozaki CK, Menard MT et al (2021) Patient comprehension necessary for informed consent for vascular procedures is poor and related to frailty. J Vasc Surg 73(4):1422–1428PubMedCrossRef
67.
Watanabe D, Yoshida T, Watanabe Y, Yamada Y, Kimura M (2020) A U-shaped relationship between the prevalence of frailty and body mass index in community-dwelling Japanese older adults: the Kyoto-Kameoka study. J Clin Med 9(5):1367PubMedCentralCrossRef
68.
69.
Hsu C-C, Sandford BA (2007) The delphi technique: making sense of consensus. Pract Assess Res Eval 12:10
70.
Shears M, Takaoka A, Rochwerg B, Bagshaw SM, Johnstone J, Holding A et al (2018) Assessing frailty in the intensive care unit: a reliability and validity study. J Crit Care 45:197–203PubMedCrossRef
Metadata
Title
Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review
Authors
Christophe Alain Fehlmann
Christian Hans Nickel
Emily Cino
Zinnia Al-Najjar
Nigèle Langlois
Debra Eagles
Publication date
21-07-2022
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine / Issue 8/2022
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-022-03042-5

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