Ivan Aprahamian, MD, MS, PhD, FACP. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, Brazil. 250 Francisco Telles street. ZIP 13.202-550. E-mail:
J Nutr Health Aging. 2019;23(7):641-647. doi: 10.1007/s12603-019-1207-9.
The number of older adults attending emergency department (ED) is increasing all over the world. Usually, those patients are potentially more complex due to their greater number of comorbidities, cognitive disorders, and functional or physical disabilities. Frailty is a vulnerable state that could predict adverse outcomes of those patients. There are very few studies that addressed this topic in the ED, and none of them used a simple instrument for frailty assessment.
The primary outcome was to evaluate the association between frailty identified through the FRAIL questionnaire at baseline and death after a 6-month follow-up period after hospital discharge from the ED. Secondary outcomes were readmission to the ED and disability after 6 months.
A 6-month follow-up prospective study (FASES study) was conducted at a university-based trauma-center ED in Jundiaí, southwestern of Brazil. A total of 316 older adults aged 60 or older were randomly included based on a lottery of their medical record admission number. Frailty was evaluated through the FRAIL questionnaire. The association between frailty and death was estimated through a binary logistic regression adjusted for age, sex, and cognitive performance.
From the total sample, the mean age was 72.11±8.0 years, and 51.6% were women. Participants presented 2.28±1.4 comorbidities and 25.6% were frail. Mean hospital stay was 5.43±5.6 days. Death occurred in 52 participants, readmission to the emergency in 55, and new disability in 16 after 6 months. Frailty was associated with an odds ratio of 2.18 for death after 6 months (95% CI = 1.10-4.31; p = 0.024). This association lost significance after multivariate analysis taking into account cognitive performance. There was no association between frailty status at baseline and readmission to the ED or disability.
The identification of frailty using the FRAIL at admission was not predictive of death after a 6-month period after discharge from the ED. Simple frailty assessment could identify patients at higher risk for death in the follow-up.
全球范围内，前往急诊部（ED）就诊的老年患者数量不断增加。这些患者通常由于合并症更多、认知障碍、功能或身体残疾而变得更加复杂。虚弱是一种脆弱状态，可能预示着这些患者的不良预后。很少有研究在 ED 中涉及这个问题，而且没有一个研究使用简单的工具来评估虚弱。
主要结局是评估基线时通过 FRAIL 问卷确定的虚弱与 ED 出院后 6 个月内死亡之间的关联。次要结局是 6 个月后 ED 再入院和残疾。
在巴西西南部 Jundiaí 的一所大学创伤中心 ED 进行了一项为期 6 个月的前瞻性研究（FASES 研究）。根据病历入院号的抽签，共随机纳入 316 名年龄在 60 岁或以上的老年患者。通过 FRAIL 问卷评估虚弱。通过调整年龄、性别和认知表现的二元逻辑回归估计虚弱与死亡之间的关联。
从总样本来看，平均年龄为 72.11±8.0 岁，51.6%为女性。参与者患有 2.28±1.4 种合并症，25.6%为虚弱。平均住院时间为 5.43±5.6 天。6 个月后有 52 名参与者死亡，55 名再入院，16 名新出现残疾。虚弱与 6 个月后死亡的比值比为 2.18（95%CI=1.10-4.31；p=0.024）。在考虑认知表现后进行多变量分析，这种关联失去了意义。基线时的虚弱状态与 ED 再入院或残疾之间没有关联。
ED 入院时使用 FRAIL 识别的虚弱并不能预测出院后 6 个月内的死亡。简单的虚弱评估可以识别出在随访中死亡风险更高的患者。
