Assessing Physiologic Reserve and Frailty in the Older Emergency Department Patient: Should the Paradigm Change?

Christian H Nickel; John Kellett

doi:10.1016/j.cger.2023.05.004

Assessing Physiologic Reserve and Frailty in the Older Emergency Department Patient: Should the Paradigm Change?

Clin Geriatr Med. 2023 Nov;39(4):475-489. doi: 10.1016/j.cger.2023.05.004. Epub 2023 Jun 14.

Authors

Christian H Nickel¹, John Kellett²

Affiliations

¹ Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, Basel CH-4031, Switzerland. Electronic address: christian.nickel@usb.ch.
² Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Denmark.

PMID: 37798060
DOI: 10.1016/j.cger.2023.05.004

Abstract

Older patients are more vulnerable to acute illness or injury because of reduced physiologic reserve associated with aging. Therefore, their assessment in the emergency department (ED) should include not only vital signs and their baseline values but also changes that reflect physiologic reserve, such as mobility, mental status, and frailty. Combining aggregated vitals sign scores and frailty might improve risk stratification in the ED. Implementing these changes in ED assessment may require the introduction of senior-friendly processes to ensure ED treatment is appropriate to the older patients' immediate discomfort, personal goals, and likely prognosis.

Keywords: Aggregated vital sign score; Clinical frailty scale; Frailty; NEWS; Prognostication; Undertriage.

Publication types

Review

MeSH terms

Aged
Aging
Emergency Service, Hospital
Frailty* / diagnosis
Geriatric Assessment
Humans
Prognosis