Frailty Screening in the Emergency Department Enables Personalized Multidisciplinary Care for Geriatric Trauma Patients

TL;DR

Screening for frailty in emergency departments helps provide personalized care for older trauma patients, improving recovery and outcomes.

Contribution

This paper presents practical frailty screening tools and implementation strategies for geriatric trauma care in emergency settings.

Findings

Frailty screening in the emergency department enables actionable management plans for geriatric trauma patients.

Screening tools can be completed via patient report, proxy input, or chart review, accommodating various clinical limitations.

Embedding screening in electronic health records and using telehealth can support coordinated, goal-directed care.

Abstract

Frailty is a multidomain reduction in physiologic reserve that impacts recovery and can contribute to poor outcomes following trauma beyond what chronological age, comorbidities, or injury severity predicts. In geriatric trauma patients, a large proportion are frail or prefrail on initial encounter in the emergency department, and because there are opportunities for actionable management plans, major trauma guidelines endorse systematic screening integrated into coordinated geriatric trauma care. We reviewed the literature and identified practical instruments used in the acute trauma setting for risk stratification. Additionally, we highlight the feasibility of using these instruments, as some can be completed via patient report, proxy input, or chart review when cognition, language, or caregiver availability limits history-taking. Implementation efforts succeed when shared mental models are leveraged and screening is embedded in the electronic health record system, linked to order sets and trigger-based pathways that offer downstream goal-directed care management, such as early mobility, delirium prevention, nutrition, medication review, and comprehensive geriatric assessment. Additionally, we highlight the importance of initiating early goals-of-care discussions and coordinating care with palliative care services. Resource-limited systems can preserve the same architecture by using nurse-led or allied staff-led screening, tele-geriatric consultation, and virtual interdisciplinary huddles. Lastly, we expand upon opportunities for longitudinal post-discharge follow-up. We describe how targeted initiatives translate research into practice, improve outcomes, and support longitudinal reassessment through in-person and telehealth follow-up visits.

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