MP016: Measuring frailty can help emergency departments identify seniors at risk of functional decline after minor injuries

Abstract

Introduction: The CETI team has shown that around 18% of otherwise independent seniors remain in a state functional decline up to six months after a minor injury. In that context, frailty may be associated with increased likelihood of decline. As most seniors consult Emergency Departments (EDs) when injured, measuring frailty may help identify those at risk of functional decline. Objectives: This study aims to 1) describe frailty in the sub-group of independent community-dwelling seniors consulting Emergency Departments (ED) for minor injuries, 2) examine the association between frailty and functional decline three months post-injury, 3) ascertain the predictive accuracy of frailty measures and Emergency Physicians’ (EPs) for functional decline. Methods: Prospective cohort in 2011-2013 among 1072 seniors aged ≥ 65, independent in basic daily activities, evaluated in Canadian EDs for minor injuries and discharged home. Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Study of Osteoporotic Fracture index (SOF). Functional decline was defined as a loss ≥ 2/28 on the Older American Resources Services scale three months post-injury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas Under the Receiver operating characteristic curve (AUC) were used to ascertain the predictive accuracy of frailty measures and EPs’ clinical judgement. Results: The SOF and CSHA-CFS were available in 342 and 1058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail and frail. These CSHA-CFS (n=1058) proportions were 51.9%, 38.3% and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The AUCs of the CSHA-CFS and the EPs’ were similar (0.548 - 0.777), while the SOF was somewhat higher (0.704 - 0.859). Conclusion: Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.