Advertisement

Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department

  • Marianne Giroux
    Correspondence
    Reprint Address: Marianne Giroux, MSc, CHU de Québec–Hôpital de l'Enfant-Jésus, 1401 18e rue, H-0601, Québec (Québec) G1J 1Z4, Canada
    Affiliations
    Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada

    Université Laval, Québec, Québec, Canada

    Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada
    Search for articles by this author
  • Marie-Josée Sirois
    Affiliations
    Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada

    Université Laval, Québec, Québec, Canada

    Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada
    Search for articles by this author
  • Valérie Boucher
    Affiliations
    Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada

    Université Laval, Québec, Québec, Canada

    Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada
    Search for articles by this author
  • Raoul Daoust
    Affiliations
    Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada

    Université de Montréal, Montréal, Québec, Canada
    Search for articles by this author
  • Émilie Gouin
    Affiliations
    Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Québec, Canada
    Search for articles by this author
  • Mathieu Pelletier
    Affiliations
    Université Laval, Québec, Québec, Canada

    Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Québec, Canada
    Search for articles by this author
  • Simon Berthelot
    Affiliations
    Université Laval, Québec, Québec, Canada

    Centre Hospitalier de l'Université Laval (CHUL), CHU de Québec, Québec, Québec, Canada
    Search for articles by this author
  • Philippe Voyer
    Affiliations
    Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada

    Université Laval, Québec, Québec, Canada

    Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada
    Search for articles by this author
  • Marcel Émond
    Affiliations
    Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada

    Université Laval, Québec, Québec, Canada

    Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada
    Search for articles by this author

      Abstract

      Background

      Delirium is underdiagnosed in seniors at emergency departments (EDs) even though it is a frequent complication and is associated with functional and cognitive decline. As frailty is an independent predictor of adverse events in seniors, screening for frailty in EDs may help identify those at risk of delirium.

      Objectives

      To assess if screening older patients for frailty in EDs could help identify those at risk of delirium.

      Methodology

      This study was part of the multicenter prospective cohort INDEED study. Patients aged ≥ 65 years, initially free of delirium, with an ED stay ≥ 8 h were followed up to 24 h after ward admission. Frailty was assessed at baseline using the Clinical Frailty Scale; seniors with a score ≥ 5/7 were considered frail. Their delirium status was assessed twice daily using the Confusion Assessment Method.

      Results

      Among the 335 included patients, delirium occurred in 20/70 frail (28.6%) patients and in 20/265 (7.6%) robust ones. After adjusting for age and sex, the risk of delirium during ED stay was 3.13 (95% confidence interval 1.60–6.21) times higher in frail than in robust patients. Time between arrival to the ED and the incidence of delirium was also shorter for frail patients than for the robust ones (adjusted hazard ratio 2.44, 95% confidence interval 1.26–4.74).

      Conclusion

      Increased frailty is associated with increased delirium during ED stays. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk of delirium.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Latham L.P.
        • Ackroyd-Stolarz S.
        Emergency department utilization by older adults: a descriptive study.
        Can Geriatr J. 2014; 17: 118-125
        • Lowthian J.
        • Curtis A.
        • Stoelwinder J.
        • McNeil J.
        • Cameron P.
        Emergency demand and repeat attendances by older patients.
        Intern Med J. 2013; 43: 554-560
        • American College of Emergency Physicians
        • American Geriatrics Society
        • Emergency Nurses Association
        • Society for Academic Emergency Medicine
        • Geriatric Emergency Department Guidelines Task Force
        Geriatric emergency department guidelines.
        Ann Emerg Med. 2014; 63: e7-25
        • Bond K.
        • Ospina M.B.
        • Blitz S.
        • et al.
        Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey.
        Healthc Q. 2007; 10: 32-40
        • Rockwood K.
        • Song X.
        • MacKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005; 173: 489-495
        • Sirois M.J.
        • Griffith L.
        • Perry J.
        • et al.
        Measuring frailty can help emergency departments identify independent seniors at risk of functional decline after minor injuries.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 68-74
        • Zdradzinski M.J.
        • Phelan M.P.
        • Mace S.E.
        Impact of frailty and sociodemographic factors on hospital admission from an emergency department observation unit.
        Am J Med Qual. 2017; 32: 299-306
        • Hominick K.
        • McLeod V.
        • Rockwood K.
        Characteristics of older adults admitted to hospital versus those discharged home, in emergency department patients referred to Internal Medicine.
        Can Geriatri J. 2016; 19: 9-14
        • Wallis S.J.
        • Wall J.
        • Biram R.W.
        • Romero-Ortuno R.
        Association of the clinical frailty scale with hospital outcomes.
        QJM. 2015; 108: 943-949
        • Turner G.
        • Clegg A.
        Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report.
        Age Ageing. 2014; 43: 744-747
        • Conroy S.P.
        • Turpin S.
        New horizons: urgent care for older people with frailty.
        Age Ageing. 2016; 45: 577-584
        • Stiffler K.A.
        • Finley A.
        • Midha S.
        • Wilber S.T.
        Frailty assessment in the emergency department.
        J Emerg Med. 2013; 45: 291-298
        • Fallon A.
        • Dyer A.
        • Nabeel S.
        • et al.
        Frailty in older patients attending an Emergency Department.
        Eur Geriatr Med. 2015; 6: S12
        • Inouye S.K.
        • Westendorp R.G.
        • Saczynski J.S.
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders: DSM-5.
        5th edn. American Psychiatric Association, Washington, DC2013
        • Inouye S.K.
        Predisposing and precipitating factors for delirium in hospitalized older patients.
        Dement Geriatr Cogn Disord. 1999; 10: 393-400
        • Laurila J.V.
        • Laakkonen M.L.
        • Tilvis R.S.
        • Pitkala K.H.
        Predisposing and precipitating factors for delirium in a frail geriatric population.
        J Psychosom Res. 2008; 65: 249-254
        • Jung P.
        • Pereira M.A.
        • Hiebert B.
        • et al.
        The impact of frailty on postoperative delirium in cardiac surgery patients.
        J Thorac Cardiovasc Surg. 2015; 149: 869-875.e2
        • Pol R.A.
        • van Leeuwen B.L.
        • Visser L.
        • et al.
        Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: a prospective cohort study.
        Eur J Vasc Endovasc Surg. 2011; 42: 824-830
        • Dasgupta M.
        • Rolfson D.B.
        • Stolee P.
        • Borrie M.J.
        • Speechley M.
        Frailty is associated with postoperative complications in older adults with medical problems.
        Arch Gerontol Geriatr. 2009; 48: 78-83
        • Oud F.M.M.
        Predictive value of VMS-screening 'Frail elderly' for delirium, falls, re-admission and mortality.
        Eur Geriatr Med. 2014; 5: S118
        • Eeles E.M.
        • White S.V.
        • O'Mahony S.M.
        • Bayer A.J.
        • Hubbard R.E.
        The impact of frailty and delirium on mortality in older inpatients.
        Age Ageing. 2012; 41: 412-416
        • Verloo H.
        • Goulet C.
        • Morin D.
        • von Gunten A.
        Association between frailty and delirium in older adult patients discharged from hospital.
        Clin Interv Aging. 2016; 11: 55-63
        • Inouye S.K.
        • Charpentier P.A.
        Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability.
        JAMA. 1996; 275: 852-857
        • Han J.H.
        • Zimmerman E.E.
        • Cutler N.
        • et al.
        Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes.
        Acad Emerg Med. 2009; 16: 193-200
        • Émond M.
        • Boucher V.
        • Carmichael P.H.
        • et al.
        Incidence of delirium in the Emergency Department and its consequences on hospital length of stay: a prospective observational multicentre cohort study in Canadian EDs.
        BMJ Open. 2018; 8: e018190
        • Fillenbaum G.G.
        • Smyer M.A.
        The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire.
        J Gerontol. 1981; 36: 428-434
        • de Jager C.A.
        • Budge M.M.
        • Clarke R.
        Utility of TICS-M for the assessment of cognitive function in older adults.
        Int J Geriatr Psychiatry. 2003; 18: 318-324
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Inouye S.K.
        • van Dyke C.H.
        • Alessi C.A.
        • Balkin S.
        • Siegal A.P.
        • Horwitz R.I.
        Clarifying confusion: the confusion assessment method. A new method for detection of delirium.
        Ann Intern Med. 1990; 113: 941-948
        • Lemiengre J.
        • Nelis T.
        • Joosten E.
        • et al.
        Detection of delirium by bedside nurses using the confusion assessment method.
        J Am Geriatr Soc. 2006; 54: 685-689
        • Laplante J.
        • Cole M.
        • McCusker J.
        • Singh S.
        • Ouimet M.A.
        [Confusion Assessment Method. Validation of a French-language version].
        Perspect Infirm. 2005; 3 (16–8, 20–2 [in French]): 12-14
        • Monette J.
        • Galbaud du Fort G.
        • Fung S.H.
        • et al.
        Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room.
        Gen Hosp Psychiatry. 2001; 23: 20-25
        • Knaus W.A.
        • Wagner D.P.
        • Draper E.A.
        • et al.
        The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.
        Chest. 1991; 100: 1619-1636
        • Hsieh F.Y.
        • Bloch D.A.
        • Larsen M.D.
        A simple method of sample size calculation for linear and logistic regression.
        Stati Med. 1998; 17: 1623-1634
        • Carter J.V.
        • Pan J.
        • Rai S.N.
        • Galandiuk S.
        ROC-ing along: evaluation and interpretation of receiver operating characteristic curves.
        Surgery. 2016; 159: 1638-1645
        • Panza F.
        • Solfrizzi V.
        • Barulli M.R.
        • et al.
        Cognitive frailty: a systematic review of epidemiological and neurobiological evidence of an age-related clinical condition.
        Rejuvenation Res. 2015; 18: 389-412
        • Joosten E.
        • Demuynck M.
        • Detroyer E.
        • Milisen K.
        Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients.
        BMC Geriatr. 2014; 14: 1
        • Provencher V.
        • Sirois M.J.
        • Emond M.
        • et al.
        Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge.
        Health Qual Life Outcomes. 2016; 14: 40
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156