School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
Age Ageing. 2023 Jul 1;52(7). doi: 10.1093/ageing/afad116.
frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30 days and 6 months amongst older adults presenting to the Emergency Department (ED).
a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables.
a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes.
older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention.
虚弱筛查有助于对最有可能发生不良事件的老年人进行分层，以便进行紧急评估和随后的干预。我们评估了识别老年人风险（ISAR）、临床虚弱量表（CFS）、维持自主性综合服务规划研究 7 项问卷（PRISMA-7）和 InterRAI-ED 在预测老年人急诊就诊后 30 天和 6 个月不良结局方面的有效性。
进行了一项针对≥65 岁的成年人的前瞻性队列研究。评估了 ISAR、CFS、PRISMA-7 和 InterRAI-ED。在 30 天和 6 个月时进行盲法随访电话访谈，以评估死亡率、急诊科再就诊、住院再入院、功能下降和入住养老院的发生率。使用 2×2 表计算筛查工具的敏感性、特异性、阴性预测值和阳性预测值。
共招募了 419 名患者；女性占 47%，平均年龄为 76.9（标准差=7.2）。虚弱的患病率在不同工具之间有所不同（CFS 为 57%，InterRAI-ED 为 70%）。在 30 天内，死亡率为 5.1%，急诊科再就诊率为 18.1%，住院再入院率为 14%，功能下降率为 47.6%，入住养老院率为 7.1%。所有工具对预测不良结局的敏感性和阳性预测值都很高。
筛查为虚弱的老年人在 30 天内发生不良结局的风险显著增加，其中 ISAR 是最敏感的工具。我们建议在急诊科实施 ISAR，以支持临床医生识别最有可能从专门的老年评估和干预中受益的老年人。
