Frailty and Clinical Outcomes of Older Patients Admitted to an Emergency Department in Japan

Abstract

Introduction Medical advances and improved living standards have increased life expectancy, and the percentage of older adults is growing rapidly. The proportion of older adults visiting the emergency department (ED) is also increasing. Frailty is recognized as a significant risk factor for adverse outcomes. Thus, emergency nurses need to assess frailty in older patients presenting to the ED. This study aimed to investigate frailty and adverse outcomes among older adults who visited the ED. Materials and methods This was a prospective observational study. The study participants included patients aged 75 years and above who were either transported or self-presented to the ED of a secondary emergency medical institution at a community acute care general hospital. Data, including frailty, vital signs, triage levels, and other variables, were collected using the screener, an adverse outcome prediction tool. Mortality and survival groups of patients were compared. Results The mortality rate as assessed by the use of the adverse outcome prediction tool was significantly higher in the high-risk group than in the low-risk group (P = 0.018). Compared with outcomes in the survival group (n = 374, 95.4%), the 90-day mortality group (n = 18, 4.6%) showed significant differences in the scores, the need for assistance with housekeeping and bathing, and cognitive impairment. Regarding triage levels, no significant differences were observed in the screener-related items between the mortality and survival groups in the urgent category. Conclusions The results of this study showed no significant difference in 90-day mortality rates when comparing triage categories, suggesting the validity of assessing older adults with adverse outcome prediction tools. Therefore, beyond research facilities, during triage, the adverse outcome prediction tool can be used to assess the frailty of older adults, providing healthcare providers with the opportunity for early intervention in older adults who are frail.

Keywords: 75 years and older; emergency department; frail older adults; risk assessment tools; triage.