Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-11T19:32:59.317Z Has data issue: false hasContentIssue false

Geriatric assessment in frail older patients in the emergency department

Published online by Cambridge University Press:  17 October 2013

Cesáreo Fernández-Alonso*
Affiliation:
Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
F Javier Martín-Sánchez
Affiliation:
Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
*
Address for correspondence: Dr Cesáreo Fernández-Alonso, Servicio de Urgencias, Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040 Madrid. Email: cesareofa@hotmail.com

Summary

Emergency care of elderly patients is frequent and complex in the emergency department. Frail older patients have a high risk of poor short-term results following emergency care. There is no practical universal or standardized tool defining frailty. It must be systematically identified in older patients at risk using a screening test, and in those who are positive, a diagnostic scale of frailty or preferably a geriatric scale adapted to emergency care is carried out. An adapted geriatric assessment including brief scales related to clinical, mental, functional and social aspects has been proposed. There are currently no geriatric intervention models with sufficient evidence in frail older patients.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Roberts, DC, McKay, MP, Shaffer, A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 2008; 51: 769–74.CrossRefGoogle ScholarPubMed
2Martín-Sánchez, FJ, Fernández Alonso, C, Gil Gregorio, P. Key points of frail elders in the Emergency Department. Med Clin (Barc) 2013; 140: 2429.CrossRefGoogle ScholarPubMed
3Strange, GR, Chen, EH. Use of emergency departments by elder patients: a five-year follow up study. Acad Emerg Med 1998; 5: 1157–62.CrossRefGoogle ScholarPubMed
4Tomás, S, Chanovas, M, Roqueta, F, Alcaraz, J, Toranzo, T, Grupo de trabajo EVADUR. EVADUR: eventos adversos ligados a la asistencia en los servicios de urgencias de hospitales españoles. Emergencias 2010; 22: 254–58.Google Scholar
5Clegg, A, Young, J, Lliffe, S, Rikkert, MO, Rockwood, K. Frailty in elderly people. Lancet 2013; 381: 752–62.CrossRefGoogle ScholarPubMed
6Sternberg, SA, Werson, SA, Karunananthan, S, Bergman, H, Clarfield, M. The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011; 59: 2129–38.CrossRefGoogle ScholarPubMed
7Duaso, E, López-Soto, A. Valoración del paciente frágil en urgencias. Emergencias 2009; 21: 362–69.Google Scholar
8Walston, J, Hadley, EC, Ferrucci, L, Guralnik, JM, Newman, AB, Studenski, SAet al.Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006; 54: 9911001.CrossRefGoogle Scholar
9Jaafar, AF, Heycock, R, George, J. Frailty – a clinical overview. Rev Clin Gerontol 2007; 17: 171–75.CrossRefGoogle Scholar
10Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, Jet al.Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M14656.CrossRefGoogle ScholarPubMed
11Mitnitski, AB, Mogilner, AJ, Rockwood, K. Accumulation of deficits as a proxy measure of aging. Sci World J 2001; 1: 323–36.CrossRefGoogle ScholarPubMed
12Rodríguez-Mañas, L, Féart, C, Mann, Get al.Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2013; 68: 6267.CrossRefGoogle ScholarPubMed
13Ferrer, A, Badia, T, Formiga, Fet al.Frailty in the oldest old: prevalence and associated factors. J Am Geriatr Soc 2013; 61: 294–96.CrossRefGoogle ScholarPubMed
14Fernández, C, González del Castillo, J, González Armengol, JJ, Martín-Sánchez, FJ. La detección del paciente anciano frágil en el área de observación de urgencias. Aten Primaria 2011; 43: 449.CrossRefGoogle Scholar
15Grossmann, FF, Zumbrunn, T, Frauchiger, A, Delport, K, Bingisser, R, Nickel, CH. At risk on undertriage? Testing the performance and accuracy of the Emergency Severity Index in older Emergency Department patients. Ann Emerg Med 2012; 60: 317–25.CrossRefGoogle ScholarPubMed
16McCusker, J, Bellavance, F, Cardin, S, Trepanier, S, Verdon, J, Ardman, O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 1999; 47: 1229–37.CrossRefGoogle ScholarPubMed
17Meldon, SW, Mion, LC, Palmer, RMet al.A brief risk stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med 2003; 10: 224–32.Google ScholarPubMed
18Moons, P, De Ridder, K, Geyskens, Ket al.Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14: 315–23.CrossRefGoogle ScholarPubMed
19Boyd, M, Koziol-McLain, J, Yates, Ket al.Emergency department case-finding for high-risk older adults: the Brief Risk Identification for Geriatric Health Tool (BRIGHT). Acad Emerg Med 2008; 15: 598606.CrossRefGoogle ScholarPubMed
20Salvi, F, Morichi, V, Grilli, Aet al.Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging 2012; 16: 313–18.CrossRefGoogle ScholarPubMed
21Baztán Cortés, JJ, González-Montalvo, JI, Solano Jaurrieta, JJ, Hornillos Calvo, M. Atención sanitaria al anciano frágil: de la teoría a la evidencia científica. Med Clin (Barc) 2000; 115: 704–17.CrossRefGoogle Scholar
22Fernández Alonso, C, Martín Sánchez, FJ, Fuentes Ferrer, Met al.Valor pronóstico de la valoración funcional al ingreso en una unidad de corta estancia de urgencias. Rev Esp Geriatr Gerontol 2010; 45: 6366.CrossRefGoogle Scholar
23Hustey, FM, Meldon, SW. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med 2002; 39: 248–53.CrossRefGoogle ScholarPubMed
24Kilshaw, L. Australian and New Zealand Society for Geriatric Medicine: Position Statement no. 14. Guidelines for the management of older persons presenting to emergency departments 2008. Australas J Ageing 2009; 28: 153–57.Google ScholarPubMed
25Samaras, N, Chevalley, T, Samaras, D, Gold, G. Older patients in the emergency department: a review. Ann Emerg Med 2010; 56: 261–69.CrossRefGoogle ScholarPubMed
26Rubenstein, LZ. The emergency department: a useful site for CGA? J Am Geriatr Soc 1996; 44: 601–2.CrossRefGoogle ScholarPubMed
27Fernández, C, González del Castillo, J, González Armengol, JJ, Martín-Sánchez, FJ. La detección del paciente anciano frágil en el área de observación de urgencias. Aten Primaria 2011; 43: 449.CrossRefGoogle Scholar
28Olsson, T, Terent, A, Lind, L. Charlson co-morbidity index can add prognostic information to rapid emergency medicine score as a predictor of long-term mortality. Eur J Emerg Med 2005; 12: 220–24.CrossRefGoogle ScholarPubMed
29Martín-Sánchez, FJ, Fernández Alonso, C, Merino, C. The geriatric patient and emergency care. An Sist Sanit Navar 2010; 33 (suppl I): 163–72.Google ScholarPubMed
30Martín-Sánchez, FJ, Martínez Agüero, M, Fernández Alonso, C, González del Castillo, J, González Armengol, JJ. Eventos adversos relacionados con la medicación en los ancianos atendidos en urgencias. Gac Sanit 2012; 26: 585CrossRefGoogle Scholar
31Justiniano, CF, Evans, DC, Cook, CHet al.Comorbidity–polypharmacy score: a novel adjunct in post-emergency department trauma triage. J Surg Res 2013; 181: 1619.CrossRefGoogle Scholar
32Rodríguez-Molinero, A, López-Diéguez, M, Tabuenca, AI, De la Cruz, JJ, Banegas, JR. Functional assessment of older patients in the Emergency Department: comparision between standard instrument, medical records and physician's perceptions. BMC Geriatr 2006; 6: 13.CrossRefGoogle Scholar
33Bissett, M, Cusick, A, Lannin, NA. Functional assessments utilized in emergency departments: a systematic review. Age Ageing 2013; 42: 163–72.CrossRefGoogle ScholarPubMed
34Rockwood, K, Mitnitski, A. Frailty, fitness and the mathematics of deficit accumulation. Rev Clin Gerontol 2007; 17: 4562.CrossRefGoogle Scholar
35Martín-Sánchez, FJ, Fernández, C, Guevara, T, Gil Gregorio, P. Valoración Neuropsiquiátrica en los Pacientes Mayores de 75 años ingresados en la Unidad de Observación de Urgencias. Rev Esp Geriatr Gerontol 2011; 46: 55.CrossRefGoogle Scholar
36Slater, H, Young, J. A review of brief cognitive assessment tests. Rev Clin Gerontol 2013; 23: 164–76.CrossRefGoogle Scholar
37Gordon, JA. Cost-benefit analysis of social work services in the emergency department: a conceptual model. Acad Emerg Med 2001; 8: 5460.CrossRefGoogle ScholarPubMed
38Fernández Alonso, C, Baratas Crespo, E, García Briñón, , Martín Sánchez, FJ. Detección de malos tratos al anciano en las urgencias hospitalarias. Aten Primaria 2011; 43: 451–52.CrossRefGoogle Scholar
39Bond, MC, Butler, KH. Elder abuse and neglect: definitions, epidemiology and approaches to emergency department screening. Clin Geriatr Med 2013; 29: 257–73.CrossRefGoogle Scholar
40Rolfson, DB, Majumdar, SR, Tsuyuki, RT, Tahir, A, Rockwood, K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006; 35: 526–29.CrossRefGoogle ScholarPubMed
41Hastings, SN, Purser, JL, Johnson, KS, Sloane, RJ, Whitson, HE. Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc 2008; 56: 1651–57.CrossRefGoogle Scholar
42Caplan, GA, Williams, AJ, Daly, B, Abraham, K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department – the DEED II study. J Am Geriatr Soc 2004; 52: 1417–23.CrossRefGoogle ScholarPubMed
43Fairhall, N, Langron, C, Sherrington, Cet al.Treating frailty – a practical guide. BMC Med 2011; 9: 83.CrossRefGoogle ScholarPubMed
44Wilhelmson, K, Duner, A, Eklund, Ket al.Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people. BMC Geriatr 2011; 11: 24.CrossRefGoogle ScholarPubMed
45Corbett, HM, Lim, WK, Davis, SJ, Elkins, AM. Care co-ordination in the Emergency Department: improving outcomes for older patients. Aust Health Rev 2005; 29: 4350.CrossRefGoogle Scholar
46Mion, LC, Palmer, RM, Meldon, SWet al.Case finding and referral model for emergency department elders: a randomized clinical trial. Ann Emerg Med 2003; 41: 5768.CrossRefGoogle ScholarPubMed
47Salvi, F, Morichi, V, Grilli, Aet al.A geriatric emergency service for acutely ill elderly patients: patterns of use and comparison with conventional emergency department in Italy. J Am Geriatr Soc 2008; 53: 2131–38.CrossRefGoogle Scholar
48Edmans, J, Conroy, C, Harwood, R, Lewis, S, Elliott, RA, Logan, P, Bradshaw, L, Franklin M, , Gladman, J.Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS). Age Ageing 2011; 40: 436–43.Google Scholar
49Bridges, J, Meyer, J, Dethick, L, Griffiths, P. Older people in accident and emergency: implications for UK policy and practice. Rev Clin Gerontol 2005; 14: 1524.CrossRefGoogle Scholar
50Latour, J, Lebel, P, Leclerc, BS, Leduc, N, Berg, K, Bolduc, A, Kergoat, MJ. Short-term geriatric assessment units: 30 years. BMC Geriatr 2010; 10: 41.CrossRefGoogle Scholar