Screening Tools for Patient Frailty in the Emergency and Urgent Care Setting: A Systematic Review

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Antonio Boncaro https://orcid.org/0000-0003-4475-5280
Alessandra Pedroni https://orcid.org/0009-0004-9024-3854
Alessio Brichese https://orcid.org/0009-0006-7205-5723
Francesca Gulino https://orcid.org/0000-0003-3817-7920
Giorgio Cardamone https://orcid.org/0009-0007-1801-7651
Lara Filippini https://orcid.org/0009-0006-7205-5723
Maria Pia Motola https://orcid.org/0000-0003-3817-7920
Elisa La Malfa https://orcid.org/0009-0009-3166-0187
Maria Bertuol https://orcid.org/0009-0004-8945-0135
Giuseppe Stirparo https://orcid.org/0000-0003-3803-9798

Keywords

Frailty, Emergency Medical Services, Urgent Care, Geriatrics, Nurses, Aged

Abstract

Background: Overcrowding in emergency departments (EDs) is a significant issue, leading to longer wait times and poor clinical outcomes, particularly affecting the elderly population. Elderly patients often visit EDs due to multiple chronic conditions and are at higher risk for hospitalization and adverse health outcomes. Frailty, an age-related condition characterized by increased vulnerability to health complications, plays a major role in this issue. Early identification of frailty can improve care and reduce ED congestion. Furthermore, boarding in the corridor, where patients, especially elderly ones, wait in hallways due to a lack of available beds, worsens overcrowding and impacts patient safety and care. Aim: This study aims to identify clinical scales for the rapid assessment of frailty in elderly patients, focusing on tools that can be integrated into daily ED workflows. Early frailty identification is key to improving clinical outcomes, reducing hospitalizations and mortality, and addressing the negative effects of corridor boarding. Materials and Methods: A systematic literature review was conducted to explore validated frailty scales suitable for emergency care settings. The PICO method was used to define the research question. Studies focusing on frailty assessment in aged patients admitted to Eds were analysed. A comprehensive search was conducted in PubMed, Embase, and Scopus with keywords like "frailty," "emergency department," and "screening." Results: Several frailty scales, including the Timed Up and Go (TUG), FRAIL Scale, and Clinical Frailty Scale (CFS), were identified as applicable in emergency settings. The Clinical Frailty Scale and Tilburg Frailty Indicator stood out for their simplicity and clinical utility. Boarding in the corridor was found to exacerbate the risks for frail patients, delaying care and leading to worse outcomes. Conclusion: Implementing a structured frailty screening system in EDs is essential to improve care, reduce hospitalizations, and address the challenges of overcrowding and corridor boarding.

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