Introduction: In its prospective cohorts of independent seniors with minor injuries, the CETIe (Canadian Emergency Team Initiative) has shown that minor injuries trigger a spiral of mobility and functional decline in 18% of those seniors up to 6 months post-injury. Because of their effects on multiple physiological systems, multicomponent mobility interventions with physical exercises are among the best methods to limit frailty and improve mobility & function in seniors. Methods: Pilot clinical trial among 4 groups of seniors, discharged home post-ED consultation for minor injuries. Interventions: 2x 1 hour /week/12 weeks with muscle strengthening, functional and balance exercises under kinesiology supervision either at home (Jintronix tele-rehabilitation platform) or at community-based programs (YWCA, PIED) vs usual ED-discharge (CONTROL). Measures: Functional Status in ADLs (Older American Ressources Scale); Global physical & social functioning (SF-12 questionnaire), physical activity level (RAPA questionnaire) at initial ED visit and at 3 months. Results: 135 seniors were included (Controls: n=50; PIED: n=28; Jintronix: n=27; YWCA: n=18). Mean age was 72.6±6.2 years, 45% were prefrail, 86% and 8% had a fall or motor vehicle-related injuries (e.g. fractures: 30%; contusions: 37%). Intervention could start as early as 7 days post-injury. Seniors in interventions (Home, YWCA or PIED) maintained or improved their functional status (84% vs 60%, p≤0.05), their physical (73% vs 59%, p=0.05) and social (45% vs 23%, p≤0.05) functioning. While 21% of CONTROLs improved their physical activity level three months post-injury, 46% of seniors in intervention did (p≤0.05). Conclusion: Exercises-based interventions can help improve seniors’ function and mobility after a minor injury.

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.