Can frailty screening be used to inform clinical decision-making for older persons in the emergency department? A systematic review

INTRODUCTION: Older adults with frailty presenting to the emergency department (ED) have worse short- and long-term outcomes than those who are not frail. Frailty screenings are often applied retrospectively to demonstrate a relationship between frailty and outcomes; it is not known whether frailty screening can inform decision-making about acuity at triage or ED disposition. PURPOSE: To determine whether the use of frailty screening at triage or during an ED stay can inform triage acuity or provide information to inform disposition decisions. METHODS: Covidence software was used to identify primary studies conducted from 2000-present with a patient population of greater than 65 years of age, presenting to the ED, which described using a frailty tool to inform clinical decision-making. Exclusion criteria comprised case reports, systematic reviews, conference abstracts, non-ED settings, written in a language other than English, or in which frailty was used as a covariant rather than a predictor. The search yielded 6360 studies for screening. 2042 duplicates were identified and removed. Of the 4318 remaining abstracts screened, 93 full-text studies met initial criteria and were assessed for eligibility, and 88 of them were excluded. Five studies were evaluated for this review. RESULTS: Early identification of frailty at triage facilitates intervention by case management or geriatric-specific care teams which can reduce ED under-triage, ED revisits, and re-admission in patients greater than 65 years of age who screen positive for frailty. CONCLUSIONS: Frailty screening processes can and should be used to identify older patients who may be more acutely ill than they initially appear at presentation, or may require more consideration at the point of discharge decision-making and may benefit from medical or case management interventions in the ED.