Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis

Elizabeth Moloney, Mark R. O’Donovan, Duygu Sezgin, Evelyn Flanagan, Keith McGrath, Suzanne Timmons and Rónán O’Caoimh ()
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Elizabeth Moloney: HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland
Mark R. O’Donovan: HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland
Duygu Sezgin: School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland
Evelyn Flanagan: HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland
Keith McGrath: Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
Suzanne Timmons: Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
Rónán O’Caoimh: HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland

IJERPH, 2023, vol. 20, issue 13, 1-18

Abstract: Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76–0.91) versus 0.77 (95% CI: 0.62–0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86–0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required.

Keywords: frailty; screening; tool; instrument; older adult; diagnostic test accuracy; emergency department; systematic review; meta-analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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