Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore.
Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afab251.
emergency department interventions for frailty (EDIFY) delivers frailty-centric interventions at the emergency department (ED). We evaluated the effectiveness of a multicomponent frailty intervention (MFI) in improving functional outcomes among older persons.
a quasi-experimental study.
a 30-bed ED observation unit within a 1,700-bed acute tertiary hospital.
patients aged ≥65 years, categorised as Clinical Frailty Scale 4-6, and planned for discharge from the unit.
we compared patients receiving the MFI versus usual-care. Data on demographics, function, frailty, sarcopenia, comorbidities and medications were gathered. Our primary outcome was functional status-Modified Barthel Index (MBI) and Lawton's iADL. Secondary outcomes include hospitalisation, ED re-attendance, mortality, frailty, sarcopenia, polypharmacy and falls. Follow-up assessments were at 3, 6 and 12 months.
we recruited 140 participants (mean age 79.7 ± 7.6 years; 47% frail and 73.6% completed the study). Baseline characteristics between groups were comparable (each n = 70). For the intervention group, MBI scores were significantly higher at 6 months (mean: 94.5 ± 11.2 versus 88.5 ± 19.5, P = 0.04), whereas Lawton's iADL scores experienced less decline (change-in-score: 0.0 ± 1.7 versus -1.1 ± 1.8, P = 0.001). Model-based analyses revealed greater odds of maintaining/improving MBI in the intervention group at 6 months [odds ratio (OR) 2.51, 95% confidence interval (CI) 1.04-6.03, P = 0.04] and 12 months (OR 2.98, 95% CI 1.18-7.54, P = 0.02). This was similar for Lawton's iADL at 12 months (OR 4.01, 95% CI 1.70-9.48, P = 0.002). ED re-attendances (rate ratio 0.35, 95% CI 0.13-0.90, P = 0.03) and progression to sarcopenia (OR 0.19, 95% CI 0.04-0.94, P = 0.04) were also lower at 6 months.
the MFI delivered to older persons at the ED can possibly improve functional outcomes and reduce ED re-attendances while attenuating sarcopenia progression.
急诊科虚弱干预（EDIFY）在急诊科提供以虚弱为中心的干预措施。我们评估了一种多成分虚弱干预（MFI）在改善老年人功能结局方面的有效性。
准实验研究。
一家 1700 张床位的急性三级医院的 30 张床位急诊科观察单元。
年龄≥65 岁、临床虚弱量表 4-6 分、计划从单元出院的患者。
我们比较了接受 MFI 与常规护理的患者。收集了人口统计学、功能、虚弱、肌少症、合并症和药物的数据。我们的主要结局是功能状态-改良巴氏量表（MBI）和劳顿的 iADL。次要结局包括住院、急诊科再就诊、死亡率、虚弱、肌少症、多药和跌倒。随访评估在 3、6 和 12 个月进行。
我们招募了 140 名参与者（平均年龄 79.7±7.6 岁；47%虚弱，73.6%完成了研究）。组间基线特征相当（每组 n=70）。对于干预组，6 个月时 MBI 评分明显更高（平均：94.5±11.2 与 88.5±19.5，P=0.04），而劳顿的 iADL 评分下降较少（评分变化：0.0±1.7 与-1.1±1.8，P=0.001）。基于模型的分析显示，干预组在 6 个月时维持/改善 MBI 的可能性更大[优势比（OR）2.51，95%置信区间（CI）1.04-6.03，P=0.04]和 12 个月时（OR 2.98，95%CI 1.18-7.54，P=0.02）。12 个月时劳顿的 iADL 也类似（OR 4.01，95%CI 1.70-9.48，P=0.002）。6 个月时急诊科再就诊（率比 0.35，95%CI 0.13-0.90，P=0.03）和进展为肌少症（OR 0.19，95%CI 0.04-0.94，P=0.04）的发生率也较低。
在急诊科为老年人提供的 MFI 可能可以改善功能结局，减少急诊科再就诊次数，同时减缓肌少症的进展。
