Core requirements of frailty screening in the emergency department: an international Delphi consensus study

Elizabeth Moloney, Mark R O'Donovan, Christopher R Carpenter, Fabio Salvi, Elsa Dent, Simon Mooijaart, Emiel O Hoogendijk, Jean Woo, John Morley, Ruth E Hubbard, Matteo Cesari, Emer Ahern, Roman Romero-Ortuno, Rosa Mcnamara, Anne O'Keefe, Ann Healy, Pieter Heeren, Darren Mcloughlin, Conor Deasy, Louise MartinAudrey Anne Brousseau, Duygu Sezgin, Paul Bernard, Kara Mcloughlin, Jiraporn Sri-On, Don Melady, Lucinda Edge, Ide O'Shaughnessy, Jill Van Damme, Magnolia Cardona, Jennifer Kirby, Lauren Southerland, Andrew Costa, Douglas Sinclair, Cathy Maxwell, Marie Doyle, Ebony Lewis, Grace Corcoran, Debra Eagles, Frances Dockery, Simon Conroy, Suzanne Timmons, Rónán O'Caoimh

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Introduction: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study. Methods: A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August–September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors. Results: In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2–4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include. Conclusions: Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.

Original languageEnglish
Article numberafae013
JournalAge and ageing
Issue number2
Publication statusPublished - 1 Feb 2024


  • Delphi consensus
  • emergency department
  • frailty screening
  • older adult
  • older people

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