title: Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR).
abstract: OBJECTIVE
  Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Comprehensive geriatric assessment (CGA) has been proposed to screen for frailty in the ED, but it is difficult to carry out. We tested whether a CGA-based approach using the Identification of Seniors At Risk (ISAR) screening tool was associated with the brief deficit accumulation index (DAI) of frailty.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Two urban EDs in Italy.
  
  
  METHODS
  A cohort of 200 elderly (≥65 years) ED patients.
  
  
  METHODS
  Identifiers, triage, clinical and social data along with the administration of ISAR. CGA was performed using: Charlson Index, Short Portable Mental Status Questionnaire and Katz's ADL. Follow-up data at 30 and 180 days included: mortality, ED revisit, hospital admission, and functional decline. Frailty was defined according to a brief DAI. Logistic regression evaluated the consistency of the frailty definition; ROC curves evaluated ISAR ability in identifying frailty.
  
  
  RESULTS
  Frailty was present in 117 (58.5%) subjects and predicted ED revisit and frequent ED return, hospitalization and 6-month mortality. ISAR had an AUC of 0.92 (95%CI 0.88-0.96, p<0.0001) in identifying frail elders in the ED and using a cut-off of 2 showed 94% sensitivity and 63% specificity.
  
  
  CONCLUSIONS
  ISAR is a useful screening tool for frailty and identifies elderly patients at risk of adverse outcomes after an ED visit. ISAR can also be used to select high-risk patients more likely to benefit from a geriatric approach or intervention, independently of admission or discharge.
authors.affiliation: Geriatric emergency Department, National Institute of Health and Research on Aging (INRCA), Ancona, Italy. F.SALVI@inrca.it
authors.forename: F
authors.initials: F
authors.lastname: Salvi
authors.forename: V
authors.initials: V
authors.lastname: Morichi
authors.forename: A
authors.initials: A
authors.lastname: Grilli
authors.forename: L
authors.initials: L
authors.lastname: Lancioni
authors.forename: L
authors.initials: L
authors.lastname: Spazzafumo
authors.forename: S
authors.initials: S
authors.lastname: Polonara
authors.forename: A M
authors.initials: AM
authors.lastname: Abbatecola
authors.forename: G
authors.initials: G
authors.lastname: De Tommaso
authors.forename: P
authors.initials: P
authors.lastname: Dessi-Fulgheri
authors.forename: F
authors.initials: F
authors.lastname: Lattanzio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires