Authors: Dr Saisaranya , Dr Shameem K U

Abstract

Background:
The global population is aging rapidly, and emergency departments (EDs) increasingly serve as a primary point of care for older adults. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, is a strong predictor of morbidity, hospitalization, and mortality. Despite its clinical relevance, frailty assessment at ED triage remains underutilized, particularly in Indian settings. The Clinical Frailty Scale (CFS) is a simple, validated tool suitable for rapid triage evaluation, yet regional data on its prevalence and prognostic utility are limited.

Objectives:
To determine the prevalence of frailty among ED patients aged ≥65 years and evaluate the ability of CFS to predict hospital admission and 30-day mortality.

Methods:
We conducted a prospective observational study from October 1, 2024, to October 1, 2025, at a 30-bed tertiary-care ED at KIMSHEALTH, Trivandrum, South India, with an annual census exceeding 45,000 adult patients. Consecutive patients aged ≥65 years presenting to triage were assessed using the CFS; frailty was defined as CFS ≥5. Outcomes included hospital admission and 30-day mortality, with predictive performance evaluated using area under the curve (AUC), sensitivity, specificity, and adjusted odds ratios. Patients in cardiac arrest, requiring immediate resuscitation, or lacking caregiver history for CFS scoring were excluded.

Results:
Among 1,250 older adults assessed at triage, frailty was highly prevalent: 52.4% were frail, 18.2% vulnerable, and 29.4% non-frail. Frail patients experienced markedly worse outcomes compared with non-frail counterparts. Hospital admission and prolonged length of stay (>72 hours) increased progressively across frailty categories, affecting approximately 45% of frail patients versus about 20% of non-frail individuals. In-hospital mortality rose from roughly 3% in non-frail patients to nearly 12% in frail patients, while 30-day mortality increased from about 4% to 15%. Adjusted analyses demonstrated that frailty independently predicted adverse outcomes, with odds ratios of approximately 3.5 for hospital admission, 3.0 for ICU admission, 3.8 for prolonged ED stay, 4.2 for in-hospital mortality, and 4.5 for 30-day mortality

Conclusion:
Frailty is highly prevalent among older adults presenting to ED triage and serves as a powerful independent predictor of admission, critical care requirement, and short-term mortality. Integrating routine frailty screening into ED workflows can enhance early geriatric risk stratification, support timely clinical decision-making, and potentially improve patient outcomes.

Keywords: Frailty; Clinical Frailty Scale; Emergency Department; Triage; Older Adults; Mortality Prediction.