TY - JOUR
T1 - Identification of older adults with frailty in the Emergency Department using a frailty index
T2 - Results from a multinational study
AU - Brousseau, Audrey-Anne
AU - Dent, Elsa
AU - Hubbard, Ruth
AU - Melady, Don
AU - Émond, Marcel
AU - Mercier, Éric
AU - Costa, Andrew P
AU - For The Multinational Emergency Department Study
AU - Gray, Leonard C
AU - Hirdes, John P
AU - Dey, Aparajit B
AU - Jonsson, Palmi V
AU - Lakhan, Prabha
AU - Ljunggren, Gunnar
AU - Singler, Katrin
AU - Sjostrand, Fredrik
AU - Swoboda, Walter
AU - Wellens, Nathalie I. H.
PY - 2018/3
Y1 - 2018/3
N2 - Objective: frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method: this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged =75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. Results: there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34-1.52]); death at 28 days (OR = 1.55 [1.38-1.73]); prolonged hospital stay (OR = 1.37 [1.22-1.54]); discharge to long-term care (OR = 1.30 [1.16-1.47]); and need for Comprehensive Geriatric Assessment (OR = 1.51 [1.41-1.60]). The multinational cohort showed similar associations. Conclusion: the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.
AB - Objective: frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method: this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged =75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. Results: there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34-1.52]); death at 28 days (OR = 1.55 [1.38-1.73]); prolonged hospital stay (OR = 1.37 [1.22-1.54]); discharge to long-term care (OR = 1.30 [1.16-1.47]); and need for Comprehensive Geriatric Assessment (OR = 1.51 [1.41-1.60]). The multinational cohort showed similar associations. Conclusion: the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.
KW - Emergency department
KW - Frail older adults
KW - Frailty index
KW - Geriatric assessment
KW - Geriatric emergency medicine
KW - Older people
UR - http://www.scopus.com/inward/record.url?scp=85043486339&partnerID=8YFLogxK
U2 - 10.1093/ageing/afx168
DO - 10.1093/ageing/afx168
M3 - Article
C2 - 29165543
AN - SCOPUS:85043486339
SN - 0002-0729
VL - 47
SP - 242
EP - 248
JO - Age and Ageing
JF - Age and Ageing
IS - 2
ER -