Frailty and mortality: Utility of Frail-VIG index in ED short-stay units for older adults.

BACKGROUND: Frailty assessment allows the identification of patients at risk of death. The aim here was to study the ability of Frail-VIG Index (FI-VIG) in order to discriminate frailty groups of older adults and garner its correlation with mortality in an Emergency-Department Short-Stay Unit (ED-SSU). METHODS: Our observational, single-center, prospective study consecutively included patients over 65-years-old admitted between March 1, 2021, and April 30, 2021. RESULTS: 302 patients were included (56 % women), mean age 83 ± 8 years, and 39.1 % of them had a functional disability whilst 16.5 % of them had dementia. A total of 174 patients (58 %) met the frailty criteria (FI-VIG ≥ 0.2): 111 (63.8 %) had mild frailty (FI-VIG 0.2-0.36), 52 (29.9 %) had moderate frailty (FI-VIG 0.36-0.55), and 11 (6.3 %) had advanced frailty (FI-VIG > 0.55). Mortality at 30 days, 6 months, and 1 year was analyzed: no frailty was 6.3 %, 10.8 %, and 12.5 %, respectively; mild frailty was 10.8 %, 22.5 %, and 22.5 %, respectively; moderate frailty was 25 %, 34.6 %, and 42.3 %, respectively; advanced frailty was 36.4 %, 54.5 %, and 3.6 %, respectively. This shows the significant differences between the groups (1-year mortality p < 0.001). Mild frailty vs. non-frail HR was 2.47 (95 %CI 1.12-5.46), moderate frailty vs. non-frail HR was 6.93 (95 %CI 3.16-15.23), and advanced frailty vs. non-frail HR was 11.29 (95 %CI 3.54-36.03). The mean test time was 7 min. CONCLUSIONS: There was a strong correlation between frailty degree and mortality at 1, 6, and 12 months. FI-VIG is fast and easy-to-use in this setting. It is routine implementation in ED-SSUs could enable early risk stratification.

Learn, unlearn, and learn again: the secret to changing how elderly patients are attended in the emergency department. / Aprender, desaprender y reaprender para asistir ancianos en urgencias: el secreto del cambio.

The demographic shift toward ever greater numbers of older patients with multiple conditions and functional dependency has increased pressure on emergency departments (EDs). The traditional approach to emergency treatment does not resolve problems in this population, creates risk, leads to high admission rates, and collapses the ED itself. Medical associations recommend that multidisciplinary teams incorporate geriatric assessment strategies and procure safe care enviroments. Implementing such recommendations will require profound changes in ED processes and staff and in connections between the ED and the community the patient is discharged to. This paper describes the processes we used in our tertiary-care hospital to achieve the necessary level of change. Our aims were to ensure that the ED staff provides correct diagnoses and treatments for elderly patients; bases decisions on the patients' clinical, social and functional needs and the preferences of both patient and family; and arranges for the most appropriate treatment environment in each case. All these changes were essential for properly addressing new care demands while achieving optimal patient outcomes and contributing to better ED and hospital performance.

El importante cambio demográfico, con el incremento de personas ancianas con multimorbilidad y dependencia funcional, conlleva un aumento de presión sobre los servicios de urgencias (SUH). En esta población, la atención clásica desarrollada en los SUH no es resolutiva, comporta riesgos para las personas, implica tasas altas de ingreso y contribuye a aumentar la saturación del propio SUH. Las sociedades científicas recomiendan incorporar estrategias de valoración geriátrica en el SUH a cargo de equipos multidisciplinares, y procurar entornos seguros. Una organización de este estilo requiere de un profundo cambio del propio servicio, de sus profesionales y de las conexiones con el entorno post-hospitalario. Exponemos la experiencia del SUH de un hospital terciario y los mecanismos utilizados para conseguir ese cambio. El objetivo es garantizar que el equipo del SUH lleve a cabo unos cuidados y un diagnóstico y tratamiento correctos de los procesos urgentes en la población anciana, tome decisiones ajustadas a las necesidades clínicas, sociales, funcionales, a los deseos del paciente y su familia, y elija el entorno de tratamiento mejor en cada caso. Todo ello son cambios imprescindibles para atender adecuadamente una nueva demanda, conseguir resultados óptimos para los pacientes y para el funcionamiento del SUH y del hospital.

Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department.

PURPOSE: Frailty and multi-morbidity have been associated with increased pressure on Emergency Departments (ED), higher hospital admissions and more risks for patients arising from the ED stay. The advantages of developing specific attention to frailty in ED have been highlighted. The benefits of these approaches are related to patients but also to organizations. The aim is to present how a Program of Care for Frailty (PCF) in an ED impacts on patient flows. METHODS: Setting: A tertiary, teaching, 550-bed urban hospital, with 80,000 adult patients/year ED attendances (43% ≥ 65 years). The three main axes of the program are (1) an ED geriatrization, implementing multidisciplinary comprehensive geriatric assessment performed by ED professionals (physician, nurses, social worker, pharmacist); (2) an elder-friendly area (EFA) inside the ED was built; (3) The ED integration in a collaborative network with others healthcare providers in the territory for a shared urgent care. RESULTS: Between 2011 and 2017, we observe a progressive increase in ED activity (+ 8.1%), in patient's age (40.9% vs 42.8% ≥ 65 years), and an increase in ambulance arrivals (+ 25.1%). The admission rate was rising until 2014 (10.8-12%). In 2014, the ED geriatrization began and networking was reinforced, and a decrease in the rate of admission (11.3%) is observed. CONCLUSIONS: Despite a progressive increase in ED activity and older people, we have observed a decrease in hospital admissions in parallel with the Program of Care for Frailty development. Systematic application of similar programs in distinct EDs would have an impact on the overall health system.