Enhancing emergency care for older persons: the role and impact of the electronic Frailty Index

Dana Shiffer; Antonio Desai; Matteo Cesari; Elena Generali; Massimiliano Greco; Gabriele Savioli; Mauro Giordano; Antonio Voza

doi:10.1007/s11357-024-01472-x

Enhancing emergency care for older persons: the role and impact of the electronic Frailty Index

Geroscience. 2025 Jan 13. doi: 10.1007/s11357-024-01472-x. Online ahead of print.

Authors

Dana Shiffer^#^{1

2}, Antonio Desai^#^{3

4}, Matteo Cesari⁵, Elena Generali^{3

4}, Massimiliano Greco^{4

6}, Gabriele Savioli⁷, Mauro Giordano⁸, Antonio Voza^{3

4}

Affiliations

¹ Department of Emergency Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. dana.shiffer@humanitas.it.
² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. dana.shiffer@humanitas.it.
³ Department of Emergency Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
⁵ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
⁶ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁷ Emergency Department, IRCCS Policlinico San Matteo, Pavia, Italy.
⁸ Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.

^# Contributed equally.

PMID: 39804559
DOI: 10.1007/s11357-024-01472-x

Abstract

As the elderly population expands, enhancing emergency department (ED) care by assessing frailty becomes increasingly vital. To address this, we developed a novel electronic Frailty Index (eFI) from ED health records, specifically designed to assess frailty and predict hospitalization, in-hospital mortality, ICU admissions, and 30-day ED readmissions. This retrospective, single-center study included patients 65 years old or older who presented to the ED of IRCCS Humanitas Research Hospital in Milan, Italy, between January 2015 and December 2019. Frailty was assessed using a novel electronic Frailty Index (eFI), based on the cumulative deficit model, incorporating 45 health deficits to quantify frailty. Patients were divided into four quartiles based on eFI scores to explore the association between frailty levels and adverse outcomes, including hospitalization, in-hospital mortality, ICU admission, and 30-day ED readmission. The study included 21,537 patients (mean age 77.4, 50.7% males). The median eFI score was 0.16. Hospitalization rates rose significantly with frailty, from 20% in the least frail quartile to 43% in the most frail. Similarly, in-hospital mortality and ICU admissions increased markedly with higher eFI scores, with mortality rates climbing from 0.44 to 5.0% across quartiles. The 30-day ED readmission rates significantly rose from 9.9 to 19.8%. For every 0.01 increase in eFI score, the odds of hospitalization, in-hospital mortality, ICU admission, and 30-day ED readmission significantly increased (P < 0.0001). Specifically, the adjusted odds ratios (OR) for hospitalization, in-hospital mortality, ICU admission, and ED readmission rose to 3.55, 14.15, 4.70, and 2.22, respectively (P < 0.0001), in the most frail compared to the least frail quartile. The integration of the eFI into ED settings can enable more precise risk stratification and resource allocation, significantly improving patient management and healthcare delivery for older persons in these urgent care contexts.

Keywords: Electronic Frailty Index; Frailty; Frailty score; Geriatric; Risk stratification.