Emergency presentations of older patients living with frailty: Presenting symptoms compared with non-frail patients

N R Simon; A S Jauslin; R Bingisser; C H Nickel

doi:10.1016/j.ajem.2022.06.046

Emergency presentations of older patients living with frailty: Presenting symptoms compared with non-frail patients

Am J Emerg Med. 2022 Sep:59:111-117. doi: 10.1016/j.ajem.2022.06.046. Epub 2022 Jun 26.

Authors

N R Simon¹, A S Jauslin², R Bingisser³, C H Nickel⁴

Affiliations

¹ Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland. Electronic address: noemi.simon@usb.ch.
² Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland. Electronic address: andrea.jauslin@usb.ch.
³ Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland. Electronic address: roland.bingisser@usb.ch.
⁴ Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland. Electronic address: christian.nickel@usb.ch.

PMID: 35834872
DOI: 10.1016/j.ajem.2022.06.046

Abstract

Background and objective: Symptoms may differ between frail and non-frail patients presenting to Emergency Departments (ED). However, the association between frailty status and type of presenting symptoms has not been investigated. We aimed to systematically analyse presenting symptoms in frail and non-frail older emergency patients and hypothesized that frailty may be associated with nonspecific complaints (NSC), such as generalised weakness.

Methods: Secondary analysis of a prospective, single centre, observational all-comer cohort study conducted in the ED of a Swiss tertiary care hospital. All presentations of patients aged 65 years and older were analysed. At triage, presenting symptoms and frailty were systematically assessed using a questionnaire. Patients with a Clinical Frailty Scale (CFS) > 4 were considered frail. Presenting symptoms, stratified by frailty status, were analysed. The association between frailty and generalised weakness was tested by logistic regression.

Results: Overall, 2'416 presentations of patients 65 years and older were analysed. Mean age was 78.9 (SD 8.4) years, 1'228 (50.8%) patients were female, and 885 (36.6%) patients were frail (CFS > 4). Generalised weakness, dyspnea, localised weakness, speech disorder, loss of consciousness and gait disturbance were recorded more often in frail patients, whereas chest pain was reported more often by non-frail patients. Generalised weakness was reported as presenting symptom in 166 (18.8%) frail patients and in 153 (10.0%) non-frail patients. Frailty was associated with generalised weakness after adjusting for age, gender and elevated National Early Warning Score 2 (NEWS) ≥ 3 (OR 1.19, CI 1.10-1.29, p < 0.001).

Conclusion: Presenting symptoms differ in frail and non-frail patients. Frailty is associated with generalised weakness at ED presentation.

Keywords: Clinical frailty scale; Emergency department; Frailty; Nonspecific complaints; Presenting symptoms; Weakness.

MeSH terms

Aged
Cohort Studies
Emergency Service, Hospital
Female
Frail Elderly
Frailty* / complications
Frailty* / diagnosis
Geriatric Assessment
Humans
Male
Muscle Weakness / etiology
Prospective Studies