Abstract
Frailty, at the core of geriatric medicine, is an important concept underpinning health problems but the rapid and valid measurement of frailty for older adults in the Emergency Department (ED) is lacking in China. The Frailty Screening Questionnaire (FSQ), has been shown to be a simple, rapid and practical tool to identify frailty in both community and inpatients settings, yet its utility in acute care settings is not well understood. To determine whether FSQ is useful to identify frailty and predict adverse outcomes in an emergency care setting. This prospective study included 350 adults aged 60 and over and admitted to the ED. The FSQ questionnaire which assessed self-reported slowness, weakness, inactivity, exhaustion, and weight loss was used to rapidly recognize frailty. FRAIL, Clinical frailty score (CFS), activities of daily living (ADL) and nutrition risk screening 2002 were also assessed. Outcome measures included all-cause 28-day mortality, ADL dependency, mechanical ventilation, length of hospital stay, and ICU readmissions 30 and 90 days after discharge. Cox proportional hazard model was used for survival comparison. The prevalence of FSQ frailty and prefrailty in older adults were 44.6% and 30.9% respectively in the emergency setting. FSQ frailty was associated with increasing age, chronic diseases, malnutrition risk, poor physical function and worse outcomes indicated by higher 28-d mortality, ADL dependency, mechanical ventilation, length of hospital stay, and ICU readmissions after discharge. The Kappa coefficient between the FSQ and FRAIL was 0.552. FSQ score was negatively correlated with grip strength and positively correlated with Barthel index, length of hospital stay and CFS score. Cox regression adjusted by epidemiological variables and chronic diseases showed FSQ and all components predicted mortality except weight loss. The FSQ is a rapid and useful tool to screen frailty and an effective tool to predict mortality in busy emergency settings.
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