AGMR

Urgent care for the elderly is a significant health problem, and despite efforts to restrain demand, many frail old people in need of urgent care must access hospital Emergency Department (ED). The prevalent ED model tends to be focused exclusively in the medical problem, but scientific evidence refers us to a holistic model for acute care of the elderly, led by interdisciplinary teams with geriatric competencies. International guidelines recommend an adaptation of EDs to the old patient. Risk stratification in ED is a useful first step to identify a patient cohort susceptible to receive targeted care in the ED. But there are no robust tools to distinguish at-risk or vulnerable patients within the ED. The lack of evidence makes experts accept “own” tools based on reasonable patient selection.This paper analyses the results of the use of a simple, self-constructed algorithm for the selection of frail patients in triage, that can be easily translated to other EDs. It is able to identify at triage a population with higher levels of urgency, higher admission rates and increased 30-day mortality rates, longer stays and a higher prevalence of delirium. Further research is needed in emergency geriatric care.

emergency department; older people; geriatric assessment; delirium; frailty; triage