Identification of older adults with frailty in the Emergency Department using a frailty index: results from a multinational study Journal Articles uri icon

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  • OBJECTIVE: frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. METHOD: this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged ≥75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. RESULTS: there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34-1.52]); death at 28 days (OR = 1.55 [1.38-1.73]); prolonged hospital stay (OR = 1.37 [1.22-1.54]); discharge to long-term care (OR = 1.30 [1.16-1.47]); and need for Comprehensive geriatric Assessment (OR = 1.51 [1.41-1.60]). The multinational cohort showed similar associations. CONCLUSION: the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.


  • Brousseau, Audrey-Anne
  • Dent, Elsa
  • Hubbard, Ruth
  • Melady, Don
  • Émond, Marcel
  • Mercier, Éric
  • Costa, Andrew
  • Gray, Leonard C
  • Hirdes, John P
  • Dey, Aparajit B
  • Jonsson, Palmi V
  • Lakhan, Prabha
  • Ljunggren, Gunnar
  • Singler, Katrin
  • Sjostrand, Fredrik
  • Swoboda, Walter
  • Wellens, Nathalie IH

publication date

  • March 1, 2018

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