Rapid clinical identification of vulnerable older adults in acute and emergency care: narrative review of short geriatric screening tools

Background Older adults presenting to emergency departments or acute wards are at increased risk of functional decline, delirium, falls, prolonged hospital stay, and early mortality. Early recognition of vulnerability is crucial for timely preventive interventions, yet specific geriatric assessment is often not performed at admission due to time limitations. Aim To provide a clinically focused synthesis of short geriatric screening tools and present a practical two-step model linking early screening with targeted clinical action. Methods This narrative review summarizes brief screening instruments that can be completed within minutes and are suitable for routine use. A targeted literature review identified tools used and evaluated available evidence on predictive accuracy, feasibility, and clinical integration. Results Rapid tools such as ISAR, TRST, PRISMA-7, and APOP allow early identification of patients at risk of functional decline, readmission, or short-term mortality. Multidomain instruments, including HARP, SHERPA, and ISAR-HP, provide broader prognostic information, supporting discharge planning and targeted follow-up. Predictive accuracy is generally moderate, with the area under the curve (AUC) typically between 0.60 and 0.70. Clinical impact depends on embedding screening into routine workflows and linking results to actionable interventions such as early mobilization, cognitive assessment, medication review, or referral to geriatric specialists. Clinical integration seems to require a tiered, two-step approach: rapid screening upon admission, followed by a comprehensive multidomain assessment on the ward. Conclusion Short geriatric screening tools are essential in acute care. A two-step approach appears to be a practical and clinically reasonable strategy for optimizing early detection and linking screening to targeted interventions. However, further research is needed to validate its effectiveness and define the optimal implementation strategy.