Core requirements of frailty screening in the emergency department: an international Delphi consensus study

doi:10.1093/ageing/afae013

. 2024 Feb 1;53(2):afae013.

doi: 10.1093/ageing/afae013.

Core requirements of frailty screening in the emergency department: an international Delphi consensus study

Elizabeth Moloney¹, Mark R O'Donovan¹, Christopher R Carpenter², Fabio Salvi³, Elsa Dent⁴, Simon Mooijaart⁵, Emiel O Hoogendijk⁶, Jean Woo⁷, John Morley⁸, Ruth E Hubbard⁹, Matteo Cesari¹⁰, Emer Ahern¹¹, Roman Romero-Ortuno^{12

13}, Rosa Mcnamara¹⁴, Anne O'Keefe¹⁵, Ann Healy¹⁵, Pieter Heeren¹⁶, Darren Mcloughlin¹⁵, Conor Deasy¹⁷, Louise Martin¹⁷, Audrey Anne Brousseau¹⁸, Duygu Sezgin¹⁹, Paul Bernard²⁰, Kara Mcloughlin²¹, Jiraporn Sri-On²², Don Melady²³, Lucinda Edge²⁴, Ide O'Shaughnessy²¹, Jill Van Damme²⁵, Magnolia Cardona²⁶, Jennifer Kirby²⁷, Lauren Southerland²⁸, Andrew Costa²⁹, Douglas Sinclair³⁰, Cathy Maxwell³¹, Marie Doyle³², Ebony Lewis³³, Grace Corcoran³⁴, Debra Eagles³⁵, Frances Dockery³⁶, Simon Conroy³⁷, Suzanne Timmons^{1

38}, Rónán O'Caoimh^{1

38

39}

Affiliations

¹ HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland.
² Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO 63110-1010, USA.
³ Department of Geriatrics and Emergency Care, INRCA-IRCCS, Ancona 5-60124, Italy.
⁴ The Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia 5000, Australia.
⁵ Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden 2300, Netherlands.
⁶ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Centre, Amsterdam 1081, Netherlands.
⁷ Department of Medicine, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
⁸ Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
⁹ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia.
¹⁰ IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan 20122, Italy.
¹¹ Department of Geriatric Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland.
¹² Discipline of Medical Gerontology, School of Medicine, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, D08 NHY1, Ireland.
¹³ Mercers Institute for Successful Ageing, St James's Hospital, Dublin 8, D08 E9P6, Ireland.
¹⁴ Emergency Department, St Vincent's University Hospital, Dublin 4, D04 T6F4, Ireland.
¹⁵ Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland.
¹⁶ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven 3000, Belgium.
¹⁷ Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland.
¹⁸ Département de médecine familiale et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, J1K 2R1, Canada.
¹⁹ School of Nursing and Midwifery, University of Galway, Galway City, H91 TK33, Ireland.
²⁰ Beaumont Hospital, Occupational Therapy, Dublin, D09V2N0, Ireland.
²¹ School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
²² Geriatric Emergency Medicine Unit, Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand.
²³ Department of Family and Community Medicine, Schwarz/Reisman Emergency Medicine Institute, Mount Sinai Health System, University of Toronto, Toronto, Ontario, ON M5G 1E2, Canada.
²⁴ Department of Physiotherapy, St James's Hospital, Dublin 8, Dublin, Ireland.
²⁵ School of Rehabilitation Science, McMaster University, Hamilton, Ontario N2L 3G1, Canada.
²⁶ Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4067, Australia.
²⁷ Urgent Care Team, University Hospital North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK.
²⁸ Department of Emergency Medicine, The Ohio State University, Wexner Medical Centre, Columbus, Ohio 43210, USA.
²⁹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8S 4L8, Canada.
³⁰ Department of Medicine, Quality, and Safety, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
³¹ Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
³² Emergency Department, University Hospital Waterford, Waterford, X91 ER8E, Ireland.
³³ UNSW School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, NSW 2052, Australia.
³⁴ Department of Physiotherapy, Beaumont Hospital, Dublin, D09V2N0, Ireland.
³⁵ Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada.
³⁶ Department of Geriatric Medicine, Beaumont Hospital, Dublin, D09V2N0, Ireland.
³⁷ MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, WC1E 6BT, UK.
³⁸ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland.
³⁹ Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland.

PMID: 38369629
PMCID: PMC10874925
DOI: 10.1093/ageing/afae013

Core requirements of frailty screening in the emergency department: an international Delphi consensus study

Elizabeth Moloney et al. Age Ageing. 2024.

. 2024 Feb 1;53(2):afae013.

doi: 10.1093/ageing/afae013.

Authors

Affiliations

¹ HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland.
² Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO 63110-1010, USA.
³ Department of Geriatrics and Emergency Care, INRCA-IRCCS, Ancona 5-60124, Italy.
⁴ The Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia 5000, Australia.
⁵ Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden 2300, Netherlands.
⁶ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Centre, Amsterdam 1081, Netherlands.
⁷ Department of Medicine, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
⁸ Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
⁹ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia.
¹⁰ IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan 20122, Italy.
¹¹ Department of Geriatric Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland.
¹² Discipline of Medical Gerontology, School of Medicine, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, D08 NHY1, Ireland.
¹³ Mercers Institute for Successful Ageing, St James's Hospital, Dublin 8, D08 E9P6, Ireland.
¹⁴ Emergency Department, St Vincent's University Hospital, Dublin 4, D04 T6F4, Ireland.
¹⁵ Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland.
¹⁶ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven 3000, Belgium.
¹⁷ Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland.
¹⁸ Département de médecine familiale et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, J1K 2R1, Canada.
¹⁹ School of Nursing and Midwifery, University of Galway, Galway City, H91 TK33, Ireland.
²⁰ Beaumont Hospital, Occupational Therapy, Dublin, D09V2N0, Ireland.
²¹ School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
²² Geriatric Emergency Medicine Unit, Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand.
²³ Department of Family and Community Medicine, Schwarz/Reisman Emergency Medicine Institute, Mount Sinai Health System, University of Toronto, Toronto, Ontario, ON M5G 1E2, Canada.
²⁴ Department of Physiotherapy, St James's Hospital, Dublin 8, Dublin, Ireland.
²⁵ School of Rehabilitation Science, McMaster University, Hamilton, Ontario N2L 3G1, Canada.
²⁶ Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4067, Australia.
²⁷ Urgent Care Team, University Hospital North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK.
²⁸ Department of Emergency Medicine, The Ohio State University, Wexner Medical Centre, Columbus, Ohio 43210, USA.
²⁹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8S 4L8, Canada.
³⁰ Department of Medicine, Quality, and Safety, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
³¹ Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
³² Emergency Department, University Hospital Waterford, Waterford, X91 ER8E, Ireland.
³³ UNSW School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, NSW 2052, Australia.
³⁴ Department of Physiotherapy, Beaumont Hospital, Dublin, D09V2N0, Ireland.
³⁵ Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada.
³⁶ Department of Geriatric Medicine, Beaumont Hospital, Dublin, D09V2N0, Ireland.
³⁷ MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, WC1E 6BT, UK.
³⁸ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland.
³⁹ Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland.

PMID: 38369629
PMCID: PMC10874925
DOI: 10.1093/ageing/afae013

Abstract

Introduction: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study.

Methods: A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors.

Results: In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include.

Conclusions: Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.

Keywords: Delphi consensus; emergency department; frailty screening; older adult; older people.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

**Figure 2**
Summary results of Rounds 1 and 2 of the e-Delphi consensus.

See this image and copyright information in PMC

References

1. DeDonato E, Hall SE, Hogan TM, Gleason LJ. Interprofessional education of emergency department team on falls in older adults. J Am Geriatr Soc 2020; 68: E7–9. - PubMed
1. Ukkonen M, Jämsen E, Zeitlin Ret al. . Emergency department visits in older patients: a population-based survey. BMC Emerg Med 2019; 19: 20. - PMC - PubMed
1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–62. Erratum in: Lancet. 2013 Oct 19;382(9901):1328. - PMC - PubMed
1. O’Caoimh R, Sezgin D, O’Donovan MRet al. . Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50: 96–104. - PubMed
1. Dam CS van, Trappenburg MC, Ter Wee MMet al. . The prognostic accuracy of clinical judgment versus a validated frailty screening instrument in older patients at the emergency department: findings of the AmsterGEM study. Ann Emerg Med 2022; 80: 422–31. - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources

[1] DeDonato E, Hall SE, Hogan TM, Gleason LJ. Interprofessional education of emergency department team on falls in older adults. J Am Geriatr Soc 2020; 68: E7–9. - PubMed

[2] DeDonato E, Hall SE, Hogan TM, Gleason LJ. Interprofessional education of emergency department team on falls in older adults. J Am Geriatr Soc 2020; 68: E7–9. - PubMed

[3] Ukkonen M, Jämsen E, Zeitlin Ret al. . Emergency department visits in older patients: a population-based survey. BMC Emerg Med 2019; 19: 20. - PMC - PubMed

[4] Ukkonen M, Jämsen E, Zeitlin Ret al. . Emergency department visits in older patients: a population-based survey. BMC Emerg Med 2019; 19: 20. - PMC - PubMed

[5] Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–62. Erratum in: Lancet. 2013 Oct 19;382(9901):1328. - PMC - PubMed

[6] Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–62. Erratum in: Lancet. 2013 Oct 19;382(9901):1328. - PMC - PubMed

[7] O’Caoimh R, Sezgin D, O’Donovan MRet al. . Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50: 96–104. - PubMed

[8] O’Caoimh R, Sezgin D, O’Donovan MRet al. . Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50: 96–104. - PubMed

[9] Dam CS van, Trappenburg MC, Ter Wee MMet al. . The prognostic accuracy of clinical judgment versus a validated frailty screening instrument in older patients at the emergency department: findings of the AmsterGEM study. Ann Emerg Med 2022; 80: 422–31. - PubMed

[10] Dam CS van, Trappenburg MC, Ter Wee MMet al. . The prognostic accuracy of clinical judgment versus a validated frailty screening instrument in older patients at the emergency department: findings of the AmsterGEM study. Ann Emerg Med 2022; 80: 422–31. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Core requirements of frailty screening in the emergency department: an international Delphi consensus study

Affiliations

Core requirements of frailty screening in the emergency department: an international Delphi consensus study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

References

MeSH terms

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

References

MeSH terms

Related information

LinkOut - more resources

Full Text Sources