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Practice Practice Pointer

Acute care assessment of older adults living with frailty

BMJ 2019; 364 doi: (Published 31 January 2019) Cite this as: BMJ 2019;364:l13
  1. Terence J Quinn, chief scientist office and stroke association senior clinical lecturer1,
  2. Simon P Mooijaart, director2,
  3. Katie Gallacher, stroke association senior clinical lecturer in primary care3,
  4. Jennifer K Burton, SCREDS clinical lecturer in geriatric medicine4
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2Institute for Evidence Based Medicine in Old Age, Leiden University Medical Centre, Leiden, Netherlands
  3. 3Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to T Quinn Terry.quinn{at} (or @DrTerryQuinn on Twitter)

What you need to know

  • Older people living with frailty are frequent users of acute care services

  • The approach to assessment of frail older adults is different to that of a younger patient

  • Assess older adults presenting to acute care for frailty syndromes (falls, immobility, incontinence, confusion), and get collateral history from caregivers

  • Establish the priorities and goals for the individual to ensure that investigations and treatment accord with what matters to them and their families

Older adults living with frailty are frequent users of emergency services. Acute care settings are stressful for patients, care givers, and staff. The focus on prompt assessment, rapid decision making, and constant patient flow make the environment less suited to the older adult. We suggest an approach for clinicians to assess older adults living with frailty who present to acute care settings such as emergency departments, medical units, or out of hours general practice. Our approach is evidence based where possible but mindful of time and resource constraints.12 We focus on assessment as early recognition of frailty and accompanying problems facilitates appropriate onward referral and management.

What is frailty and why does it matter?

Frailty is something all clinicians recognise, but there is little consensus on its definition.3 It can be defined by characteristics such as gait speed and grip strength,4 or described as an accumulation of age related diagnoses, symptoms and problems.5 Both models share a core concept of increased risk of adverse outcomes from illness.

Observational registries suggest that, in general, older adults tend to be more unwell on presentation, have longer hospital stays, and poorer outcomes.67 A systematic review (26 studies) of older adults discharged from emergency departments reported readmission rates as high as 40% at 6 months.8 These readmissions may represent unresolved medical issues, failure of community support, or both. Regardless, data suggest the potential …

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