Loss of Independence - a Rapid Alternative to Frailty Screening in a Swedish ED Setting

Study Overview
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Brief Summary
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This prospective observational study will investigate the correlation of a surrogate marker 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 Loss of Independence (LOI) a possible low-cost quick tool to identify frailty in patients. The study population will be 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.

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 Loss of Independence (LOI) defined as inability to rise from a chair with or without existing aids, is a possible low cost surrogate marker to measure frailty. Several studies on triage scores for predicting mortality and need of hospital admission have identified LOI as one of the most important variables. LOI was prognostic in ED populations regarding mortality within 1-30 days in Denmark, Ireland and Tanzania. Data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Geriatric Surgery Pilot Project showed that LOI was associated with higher rates of readmission and death after discharge in geriatric patients undergoing surgical procedures6. The aim of this study will be to investigate if the frailty, as assessed with LOI, is associated with increased 30-day mortality in a Swedish ED context. Secondary outcomes include 7- and 90-day mortality, ED-length of stay, hospital admission, in-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 multicentre 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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Loss of Independence (LOI) - a Rapid Alternative to Frailty Screening in a Swedish Emergency Department Setting

Conditions
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Frailty, Frailty Syndrome, Emergency Department, Geriatric Assessment

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥ 65 years able to answer questions to estimate frailty or have a proxy to answer questions Exclusion Criteria: <65 years unable to answer questions to estimate frailty

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 30 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 | 
| In-hospital length of stay | Investigate in-hospital length of stay | In-hospital length of stay from index visit, censored at 90 days | 
| Revisits to the ED | Number of newly registered visits to the ED after index visit | Number of newly registered visits to the ED after index visit, censored at 90 days | 
| Fall prevalence after index visit | Falls that resulted in further health care contacts | Falls that resulted in further health care contacts after index visit, censored at 90 days | 
| Alterations in medication during the visit | Alterations in medication during the ED visit and during the follow-up period(based on codes for Anatomical, Therapeutic, Chemical classification (ATC-code) | Alterations in medication during the ED visit and during the follow-up period, censored at 90 days |