Patient Experience of CFS-assessment in the ED

An increasingly common subject of interest among emergency care research is frailty, which is commonly described as a decline in several inter-related physiological systems, in addition to an increased vulnerability to stressors. To increase emergency care staffs ability to intervene appropriately in patients who need interventions to improve their outcomes, geriatric emergency care guidelines include recommendations to identify frailty during the emergency department (ED) visit. However, the patients´ experience of frailty assessment in general is sparsely investigated, and such studies within the ED context are even more limited.

It is conceivable that the patients experience of a frailty assessment may differ depending on several different factors, including which assessment tool is used.

A large number of assessment tools have been developed to help identify frailty, of which the Clinical Frailty Scale (CFS) is one of the most widely used. The CFS has been validated for persons ≥65 years of age and has been evaluated for validity, reliability and feasibility in an ED-setting. The CFS consists of pictograms combined with clinical descriptions of a persons level of functioning in daily life and cognitive status. Hence, to determine the CFS-score, the healthcare staff needs to ask the patient about their physical activity and function level regarding instrumental and personal activities of daily living (eg, banking, shopping, medication management, housekeeping, dressing and hygiene matters).

Since the different questions are often not directly linked to the patients acute illness, but touch on personal subjects like the persons abilities and life situation, it is desirable to understand the patients experience of such an assessment in order to optimise the approach from a patient perspective. To the best of our knowledge, there are no studies that focus on how patients experience being assessed with CFS during their ED-visit.

The aim of this study is therefore to inform a model to guide emergency department staff in assessing frailty with CFS, directed by the perspective from patients along the frailty trajectory. Specifically, our question is:

- How do older ED-patients experience the frailty assessment with the CFS?

With the nature of qualitative data, a definitive sample size cannot be determined in advance. An estimate is that data will need to be collected for 15-25 patients. The analysis is planned to start in parallel with the data collection, and when no further significant findings are made during the progress of the analysis, the data collection will end. To ensure study quality, a reflexive approach and data-/researcher triangulation will be applyed.

Eligibility Criteria:
Inclusion Criteria:

* Patients aged ≥ 65 years attending the ED, and who gives informed consent to participating in the study.
* Emergency department staff will be included if they are to perform a CFS assessment on a patient eligible for the study.

Exclusion Criteria:

* Patients who lack cognitive capacity to give informed consent, or have an acute medical condition will be excluded from the study. Exclusion will also apply to patients who do not speak Swedish and where an interpreter cannot be arranged (the patients next of kin will not be used as an interpreter).
* Exclusion criteria for staff will be unwillingness to give informed consent.