Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2023

Open Access 01-12-2023 | Triage | Research

Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments

Authors: Ann-Sofie Källberg, Lena M Berg, Sara Skogli, Charlotte Bjurbo, Åsa Muntlin, Anna Ehrenberg

Published in: BMC Geriatrics | Issue 1/2023

Login to get access

Abstract

Background

Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited.

Aim

To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs.

Methods

The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes.

Results

A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care.

Conclusion

Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.
Literature
1.
2.
Wan He DG, Kowal P. An aging world: 2015. Washington DC; 2016.
3.
Gruneir A, Silver MJ, Rochon PA. Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev. 2011;68(2):131–55.PubMedCrossRef
4.
Dent E, Hoogendijk EO, Cardona-Morrell M, Hillman K. Frailty in emergency departments. Lancet. 2016;387(10017):434.PubMedCrossRef
5.
6.
Ackroyd-Stolarz S, Read Guernsey J, Mackinnon NJ, Kovacs G. The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: a retrospective cohort study. BMJ Qual Saf. 2011;20(7):564–9.PubMedCrossRef
7.
8.
Berg LM, Ehrenberg A, Florin J, Ostergren J, Discacciati A, Goransson KE. Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of Acute Hospital Care on departure from the Emergency Department. Ann Emerg Med. 2019;74(3):345–56.PubMedCrossRef
9.
Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS ONE. 2018;13(8):e0203316.PubMedPubMedCentralCrossRef
10.
Gill TM, Allore HG, Gahbauer EA, Murphy TE. Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010;304(17):1919–28.PubMedPubMedCentralCrossRef
11.
Haines TP, Williams CM, Hill AM, McPhail SM, Hill KD, Brauer SG, et al. Depressive symptoms and adverse outcomes from hospitalization in older adults: secondary outcomes of a trial of falls prevention education. Arch Gerontol Geriatr. 2015;60(1):96–102.PubMedCrossRef
12.
Kreindler SA, Cui Y, Metge CJ, Raynard M. Patient characteristics associated with longer emergency department stay: a rapid review. Emerg Med J. 2016;33(3):194–9.PubMedCrossRef
13.
Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39(3):238–47.PubMedCrossRef
14.
Perdahl T, Axelsson S, Svensson P, Djarv T. Patient and organizational characteristics predict a long length of stay in the emergency department - a Swedish cohort study. Eur J Emerg Med. 2017;24(4):284–9.PubMedCrossRef
15.
16.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRef
17.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.PubMedPubMedCentralCrossRef
18.
Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodriguez-Manas L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771–87.PubMedPubMedCentralCrossRef
19.
20.
Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, et al. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med. 2022;13(2):309–17.PubMedCrossRef
21.
Elliott A, Hull L, Conroy SP. Frailty identification in the emergency department-a systematic review focussing on feasibility. Age Ageing. 2017;46(3):509–13.PubMedCrossRef
22.
23.
Fehlmann CA, Nickel CH, Cino E, Al-Najjar Z, Langlois N, Eagles D. Frailty assessment in emergency medicine using the clinical Frailty Scale: a scoping review. Intern Emerg Med. 2022;17(8):2407–18.PubMedPubMedCentralCrossRef
24.
Elliott A, Taub N, Banerjee J, Aijaz F, Jones W, Teece L, et al. Does the clinical Frailty Scale at Triage Predict outcomes from Emergency Care for Older people? Ann Emerg Med. 2021;77(6):620–7.PubMedCrossRef
25.
Fallon A, Kilbane L, Briggs R, Dyer A, Nabeel S, McElwaine P, et al. Screening for frailty in older emergency department patients: the utility of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument. QJM. 2018;111(3):151–4.PubMedCrossRef
26.
Salvi F, Morichi V, Lorenzetti B, Rossi L, Spazzafumo L, Luzi R, et al. Risk stratification of older patients in the emergency department: comparison between the identification of seniors at Risk and Triage Risk Screening Tool. Rejuvenation Res. 2012;15(3):288–94.PubMedCrossRef
27.
Jorgensen R, Brabrand M. Screening of the frail patient in the emergency department: a systematic review. Eur J Intern Med. 2017;45:71–3.PubMedCrossRef
28.
Welstead M, Jenkins ND, Russ TC, Luciano M, Muniz-Terrera G. A systematic review of Frailty trajectories: their shape and influencing factors. Gerontologist. 2021;61(8):e463–e75.PubMedCrossRef
29.
Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1):139.PubMedPubMedCentralCrossRef
30.
Stiffler KA, Finley A, Midha S, Wilber ST. Frailty assessment in the emergency department. J Emerg Med. 2013;45(2):291–8.PubMedCrossRef
31.
Provencher V, Sirois MJ, Ouellet MC, Camden S, Neveu X, Allain-Boule N, et al. 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. 2015;63(5):860–8.PubMedCrossRef
32.
Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, et al. Which frailty scale for patients admitted via Emergency Department? A cohort study. Arch Gerontol Geriatr. 2019;80:104–14.PubMedCrossRef
33.
Liu H, Shang N, Chhetri JK, Liu L, Guo W, Li P, et al. A Frailty Screening Questionnaire (FSQ) to rapidly predict negative Health outcomes of older adults in Emergency Care settings. J Nutr Health Aging. 2020;24(6):627–33.PubMedCrossRef
34.
Kajsa E, Katarina W, Sten L, Synneve ID. Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument. BMC Emerg Med. 2016;16(1):27.PubMedPubMedCentralCrossRef
35.
Schoenenberger AW, Bieri C, Ozguler O, Moser A, Haberkern M, Zimmermann H, et al. A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. Am J Emerg Med. 2014;32(6):623–8.PubMedCrossRef
36.
Chen LK. Frailty assessment and management in the emergency department. Arch Gerontol Geriatr. 2022;103:104805.PubMedCrossRef
37.
Norton EC, Dowd BE, Maciejewski ML. Marginal effects-quantifying the effect of changes in risk factors in logistic regression models. JAMA. 2019;321(13):1304–5.PubMedCrossRef
38.
Preston L, Chambers D, Campbell F, Cantrell A, Turner J, Goyder E. What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review. Health Services and Delivery Research. Southampton (UK). 2018.
39.
Horlin E, Munir Ehrlington S, Henricson J, John RT, Wilhelms D. Inter-rater reliability of the clinical Frailty Scale by staff members in a Swedish emergency department setting. Acad Emerg Med. 2022;29(12):1431–7.PubMedPubMedCentralCrossRef
40.
van Dam CS, Trappenburg MC, Ter Wee MM, Hoogendijk EO, de Vet R, Smulders YM, et al. The Prognostic Accuracy of Clinical Judgment Versus a validated Frailty Screening Instrument in older patients at the Emergency Department: findings of the AmsterGEM Study. Ann Emerg Med. 2022;80(5):422–31.PubMedCrossRef
41.
Hammami S, Zarrouk A, Piron C, Almas I, Sakly N, Latteur V. Prevalence and factors associated with frailty in hospitalized older patients. BMC Geriatr. 2020;20(1):144.PubMedPubMedCentralCrossRef
42.
Simon NR, Jauslin AS, Bingisser R, Nickel CH. Emergency presentations of older patients living with frailty: presenting symptoms compared with non-frail patients. Am J Emerg Med. 2022;59:111–7.PubMedCrossRef
43.
Huang YL, McGonagle M, Shaw R, Eastham J, Alsaba N, Lin CC, et al. Models of care for frail older persons who present to the emergency department: a scoping review of the literature. Int Emerg Nurs. 2023;66:101250.PubMedCrossRef
44.
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92.PubMedCrossRef
45.
Naseer M, Agerholm J, Fastbom J, Schon P, Ehrenberg A, Dahlberg L. Factors associated with emergency department revisits among older adults in two Swedish regions: a prospective cohort study. Arch Gerontol Geriatr. 2020;86:103960.PubMedCrossRef
46.
Lewis S, Evans L, Rainer T, Hewitt J. Screening for Frailty in Older Emergency Patients and Association with Outcome. Geriatr (Basel). 2020;5(1).
47.
Hjalmarsson A, Holmberg M, Asp M, Ostlund G, Nilsson KW, Kerstis B. Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study. BMC Emerg Med. 2020;20(1):94.PubMedPubMedCentralCrossRef
48.
Boreskie KF, Hay JL, Boreskie PE, Arora RC, Duhamel TA. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr. 2022;22(1):13.PubMedPubMedCentralCrossRef
Metadata
Title
Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments
Authors
Ann-Sofie Källberg
Lena M Berg
Sara Skogli
Charlotte Bjurbo
Åsa Muntlin
Anna Ehrenberg
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Triage
Published in
BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-023-04545-2

Other articles of this Issue 1/2023

BMC Geriatrics 1/2023 Go to the issue

Research

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

Research

Frailty trajectories and associated factors in the years prior to death: evidence from 14 countries in the Survey of Health, Aging and Retirement in Europe

Research

Effect of interprofessional and intraprofessional clinical collaboration on patient related outcomes in multimorbid older patients – a retrospective cohort study on the Intensive Collaboration Ward

Research

To validate the integral conceptual model of frailty among community-dwelling older adults in China: a cross-sectional study

Research

Examining the association between neuropsychiatric symptoms among people with dementia and caregiver mental health: are caregiver burden and affiliate stigma mediators?

Research

Machine learning analyses identify multi-modal frailty factors that selectively discriminate four cohorts in the Alzheimer’s disease spectrum: a COMPASS-ND study
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits