Frailty Screening in the Swedish Emergency Department Setting

Study Overview
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Brief Summary
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This prospective observational study will investigate the correlation of frailty in relation to serious outcomes. Serious outcomes are defined as: mortality within 30 days, admission to hospital, length of stay in the Emergency Department(ED), in hospital length of stay and revisits to the ED. The exposure, frailty, will be assessed according to Clinical Frailty Scale. ED patients >65 years of age in a Swedish regional health care system (Region Östergötland, Sweden) comprising three EDs in Linköping, Norrköping and Motala. The outcomes will be compared according to the degree of frailty and censored over 7, 30 and 90 days respectively.

Detailed Description
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Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality. The clinical frailty scale (CFS) is a measure of frailty based on clinical judgement in a 9 level scale, categorized as vulnerable (1-4), mildly frail (5), moderatly frail (6) and severely and very severely frail (7-8).. A validation study of the CFS in community-dwelling older people showed that it performed better than measures of cognition, function or comorbidity in assessing risk for death. In a prospective observational study including consecutive ED patients aged 65 years or older The Hosmer-Lemeshow test indicated a good agreement between predicted probability and observed frequency of 30-day mortality and ICU admission. The aim of this study will be to investigate if the fraily, assessed according to CFS, is associated with increased 30-day mortality. in a Swedish Emergency Care context. Secondary outcomes included 7-and 90-day mortality, ED length of stay, hospital admission, hospital length of stay, subsequent falls and medication changes. Additionally, we collect data on morbidity and comorbidities to assess the association with the level of frailty. Since this is a multicenter study, possible geographic differences will be studied as well. Based on the results of this study, possible interventions could be identified to improve the care of the frail geriatric patients presenting at the ED.

Official Title
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Frailty Screening in the Swedish Emergency Department Setting

Conditions
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Frailty, Frailty Syndrome, Emergency Department, Geriatric Assessment, CFS

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥65 years, able to answer any questions, alternatively have a proxy Exclusion Criteria: - Patients: <65 years

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality in 30 days | Investigate level of mortality in cohort at 30 days | All cause mortality up to 90 days from index visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality in 7 and 90 days | Investigate level of mortality in cohort at 7 and 90 days | All cause mortality up to 90 days from index visit | 
| Admission to hospital | Investigate level of all cause admissions in cohort | Hospital admission on index visit, censored at 90 days | 
| ED length of stay | Investigate length of stay at ED | Length of stay at ED, censored at 4 days | 
| Hospital length of stay | Investigate hospital length of stay | Hospital length of stay from index visit, censored at 90 days | 
| Revisitis to the ED | Number of newly registered visits to the emergency department after index visit | Number of newly registered visits to the emergency department after index visit, censored at 90 days | 
| Fall prevalence after the index visit | Falls that resulted in further ED visits | Falls that resulted in further ED visits after index visit, censored in 90 days | 
| Alterations in medication during the visit (based on codes for Anatomical, Therapeutic, Chemical classification (ATC-code)) | Alterations in medication and during the follow-up period | Alterations in medications from index visit and during the follow-up period, censored at 90 days |