title: Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review.
abstract: BACKGROUND
  Older adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature.
  
  
  METHODS
  PubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting.
  
  
  RESULTS
  IN THE BROAD CLINICAL LITERATURE, THREE TYPES OF MEASURES CAN BE IDENTIFIED: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature.
  
  
  CONCLUSIONS
  There is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.
authors.affiliation: Interdisciplinary PhD (C), Dalhousie University, Halifax, Nova Scotia, Canada ; Emergency Health Services Nova Scotia, Halifax, Canada.
authors.forename: Judah P
authors.initials: JP
authors.lastname: Goldstein
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Andrew
authors.forename: Andrew
authors.initials: A
authors.lastname: Travers