Íde O’Shaughnessy1,2 , Robert Briggs3, Suzanne Timmons2,Conal Cunningham3
1Occupational Therapy Department, St. James’s Hospital,Dublin, Ireland
2Centre for Gerontology and Rehabilitation,University College Cork, Cork, Ireland
3Medicine for Older Persons Directorate, St. James’s Hospital, Dublin, Ireland
Background: An emergency department (ED) visit is often considered a sentinel event for
an older person due to elevated risks of deleterious outcomes.This prospective cohort study
explored factors associated with disposition post ED index visit and unscheduled 30 day
Methods: Consecutive EDattendees aged≥70 years, andManchester Triage System 3-5, in
a 6-month period, were eligible for inclusion. Participants underwent an interdisciplinary
assessment by a Home FIRsT (Frailty Intervention & Response Team) member. Logistic
regression analyses were performed to identify factors predictive of admission post ED index
visit and unscheduled revisit. Predictive validity of frailty instruments were performed using
receiver operating characteristic (ROC) curves.
Results: 1,156 ED attendances were included - 59% were female; median age was 80
years; 66% were discharged home post index visit; 17.8% had an unscheduled ED revisit
within 30 days. Age and sex did not predict hospital admission. Hospital admission post
ED visit was imperfectly predicted by mild-moderate frailty: Clinical Frailty Scale 5-6
(Odds Ratio (OR) 1.83 (95% CI 1.11 – 3.04), p=0.019); ‘Think Frailty’ 3 (OR 1.75
(95% CI 1.07 – 2.85), p=0.025) and 4 (OR 2.32 (95% CI 1.16 – 4.63), p=0.017).
Paradoxically, higher frailty scores were not predictive. Cognitive impairment (4AT 1-3)similarly predicted admission (OR 1.62 (95% 1.16 – 2.27, p=0.005), while delirium (4AT
≥4) was the strongest predictor of admission (OR 5.87 (95% CI 3.17 – 10.88, p<0.001). ROC curves of both frailty scales showed moderate ‘diagnostic accuracy’ for admission, but
less so for unscheduled revisits.
Conclusion: Home FIRsT operationalised the assessment of frailty and delirium in the ED.
Delirium is a strong predictor of admission post ED index visit, more than frailty status.
Older persons have a high rate of 30-day unscheduled revisits; however, it is difficult to
produce models from patient information available at index visit that can reliably predict