JNHA: Nutrition

The journal of nutrition, health & aging

, Volume 16, Issue 4, pp 313-318

Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR)

  • Fabio SalviAffiliated withGeriatric Emergency Department, National Institute of Health and Research on Aging (I.N.R.C.A.)U.O. Punto di Primo Intervento, I.N.R.C.A. — POR Ancona Email author 
  • , V. MorichiAffiliated withGeriatric Emergency Department, National Institute of Health and Research on Aging (I.N.R.C.A.)
  • , A. GrilliAffiliated withGeriatric Emergency Department, National Institute of Health and Research on Aging (I.N.R.C.A.)
  • , L. LancioniAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche
  • , L. SpazzafumoAffiliated withStatistic and Biometry Center, National Institute of Health and Research on Aging (I.N.R.C.A.)
  • , S. PolonaraAffiliated withEmergency Department, Azienda Ospedali Riuniti
  • , A. M. AbbatecolaAffiliated withScientific Direction, National Institute of Health and Research on Aging (I.N.R.C.A.)
  • , G. De TommasoAffiliated withGeriatric Emergency Department, National Institute of Health and Research on Aging (I.N.R.C.A.)
  • , P. Dessi-FulgheriAffiliated withDepartment of Internal Medicine, University Politecnica delle Marche
    • , F. LattanzioAffiliated withScientific Direction, National Institute of Health and Research on Aging (I.N.R.C.A.)

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Abstract

Objectives

Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Comprehensive geriatric assessment (CGA) has been proposed to screen for frailty in the ED, but it is difficult to carry out. We tested whether a CGA-based approach using the Identification of Seniors At Risk (ISAR) screening tool was associated with the brief deficit accumulation index (DAI) of frailty.

Design

Prospective observational study.

Setting

Two urban EDs in Italy.

Participants

A cohort of 200 elderly (≥65 years) ED patients.

Measurements

Identifiers, triage, clinical and social data along with the administration of ISAR. CGA was performed using: Charlson Index, Short Portable Mental Status Questionnaire and Katz’s ADL. Follow-up data at 30 and 180 days included: mortality, ED revisit, hospital admission, and.functional decline. Frailty was defined according to a brief DAI. Logistic regression evaluated the consistency of the frailty definition; ROC curves evaluated ISAR ability in identifying frailty.

Results

Frailty was present in 117 (58.5%) subjects and predicted ED revisit and frequent ED return, hospitalization and 6-month mortality. ISAR had an AUC of 0.92 (95%CI 0.88–0.96, p<0.0001) in identifying frail elders in the ED and using a cut-off of 2 showed 94% sensitivity and 63% specificity.

Conclusion

ISAR is a useful screening tool for frailty and identifies elderly patients at risk of adverse outcomes after an ED visit. ISAR can also be used to select high-risk patients more likely to benefit from a geriatric approach or intervention, independently of admission or discharge.

Key words

Frailty screening emergency department outcome geriatric assessment