Top 7 Things to Know About Frailty in the Emergency Department

Introduction

Adults over age 65 represent the fasting growing segment of the US population and grew by 34% in just the past 10 years.^[1] The accumulated co-morbidities and subsequent vulnerabilities in older adults present a unique challenge in emergency departments, particularly when triaging frailty in the ED.^[2] There are several definitions of frailty, each of which represent a distinct framework of illness, resulting in different “phenotypes” of frailty.³ Among these, physical frailty is characterized by the presence of at least three of five clinical manifestations: slow walking speed, fatigue, low physical activity, weight loss, and weakness.³ Assessing frailty in a busy emergency department can be daunting. However, rapid screening tools are available and well-validated in ED settings. Additionally, EDs are positioned to not only triage and stabilize, but also provide evidence-based interventions to aid frail older adults. Furthermore, research indicates that early intervention of frailty may improve mobility, reduce risk of falls, improve independence of activities of daily living (ADLs), positively impact self-reported quality of life, and even reduce mortality.^4-9 Listed below are seven things every ED provider should know about frailty. 

Conclusion

Frailty is the manifestation of reduced physiologic reserves and heralds increased risk of complications, further clinical decompensation, and recurrent ED visits or hospitalizations. Several brief screening tools have been validated in ED settings, including the Clinical Frailty Scale. ED clinicians should first focus on stabilizing the patient and ruling out high-acuity conditions, mimics, and reversible causes. However, failing to identify frailty as the underlying cause of illness increases the likelihood of future ED visits. Rather than act as a revolving door of readmissions, emergency departments can alter the trajectory of illness by involving multi-disciplinary teams. While easy to overlook, referrals to appropriate services prior to discharge ensure that care of underlying comorbidities extends beyond the emergency department and improve measurable health outcomes for patients. 

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