title: Measuring Frailty Can Help Emergency Departments Identify Independent Seniors at Risk of Functional Decline After Minor Injuries.
abstract: This study aims to (i) describe frailty in the subgroup of independent community-dwelling seniors consulting emergency departments (EDs) for minor injuries, (ii) examine the association between frailty and functional decline 3 months postinjury, (iii) ascertain the predictive accuracy of frailty measures and emergency physicians' for functional decline.
  
  
  
  Prospective cohort in 2011-2013 among 1,072 seniors aged 65 years or older, independent in basic daily activities, evaluated in Canadian EDs for minor injuries.Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty scale (CSHA-CFS) and the Study of Osteoporotic Fracture frailty index (SOF). Functional decline was defined as a loss ≥2/28 on the Older American Resources Services scale 3 months postinjury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas under the receiver operating characteristic curve were used to ascertain the predictive accuracy of frailty measures and emergency physicians' clinical judgment.
  
  
  
  The SOF and CSHA-CFS were available in 342 and 1,058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail, and frail. These CSHA-CFS (n = 1,058) proportions were 51.9%, 38.3%, and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The Areas under the receiver operating characteristic curves of the CSHA-CFS and the emergency physicians' were similar (0.548-0.777), while the SOF was somewhat higher (0.704-0.859).
  
  
  
  Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, Québec, Canada. Marie-Josee.Sirois@rea.ulaval.ca.|Département de réadaptation, Université Laval, Québec, Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Sirois
authors.affiliation: Department of Clinical Epidemilogy & Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Griffith
authors.affiliation: Emergency Department, Ottawa Hospital Research Institute, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perry
authors.affiliation: Départment d'urgence, Hôpital du Sacré-Coeur de Montréal, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Daoust
authors.affiliation: École de Réadaptation, Université de Montréal, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Veillette
authors.affiliation: Emergency Department, Sunnybrooke Health Sciences Center, Toronto, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lee
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, Québec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pelletier
authors.affiliation: Emergency Department, Ottawa Hospital Research Institute, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Wilding
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, Québec, Canada.|Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D057187:Independent Living; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014947:Wounds and Injuries / Q000209:etiology*
keywords: Emergency department; Frailty; Functional decline; Injuries; Seniors