| Popis: |
Introduction: Older People are attending Emergency Departments (EDs) in increasing numbers worldwide. As frailty is predictive of adverse outcomes, the identification of frailty in ED has been recommended to prompt interdisciplinary assessment and individualised care planning, but the optimal assessment measures to use have yet to be established. The aim of this study was to examine the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary frailty assessment team in the ED and determine any associations with frailty prevalence and clinical outcomes. Methods: This observational cross-sectional study recruited adults ≥70 years who were assessed by an interdisciplinary frailty assessment team on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference, Timed Up and Go (TUG), gait speed and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Results: Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IQR 2.0), range 1-7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. TUG was completed in 13.9% (n = 34) of participants with median TUG 13.09 seconds (IQR 9.64). Gait speed was measured in 10.2% (n = 26) of participants with median gait speed 1.03 metres per second (IQR 0.48). Grip strength was significantly associated with frailty even after adjusting for age (p < 0.0001), gender (p < 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p < 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028). Conclusion: Grip strength in addition to a validated tool such as CFS may assist ED staff in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. TUG and gait speed would not be recommended as formal mobility outcome measures were difficult to obtain in the ED environment however, functional mobility assessment was important to determine the need for hospital admission. |
