Adultos mayores con fragilidad que consultan en Urgencias

Introduction

Managing the care of older adults with frailty is currently a major challenge, especially in the Emergency Department (ED) and the Acute Medical Unit (AMU). The aim of this paper is to describe the use of healthcare resources of patients with frailty admitted to the AMU.

Methods

Prospective, descriptive and observational study, from March 2022 to March 2023. Patients admitted to the AMU ≥ 85-years-old with moderate-advanced frailty and < 85-years-old from selected risk groups (from nursing homes, dementia and advanced chronic disease) were analysed. The degree of frailty was classified according to the Clinical Frailty Scale (CFS). Demographic data, clinical data, conventional hospitalisation and alternatives to conventional hospitalisation (intermediate care, hospital at home), advanced care planning, 3-months mortality after discharge and hospital readmissions between 72 hours and 28 days after discharge were assessed.

Results

A total of 354 patients were studied, of whom 202 (57%) were female; mean age 87.7 ± 3.83 years. 212 (60%) patients were admitted to some alternative to conventional hospitalisation, 120 (56.6%) intermediate care and 92 (43.4%) hospital at home). 138 (39%) patients had a previous assessment by primary care and 85 (24%) patients had advance care planning. 3-months mortality after discharge was 78 patients (22%) and readmissions were 73 patients (20.6%).

Conclusions

The AMU is a key area for tailoring urgent care for older people with frailty, optimising the use of alternatives to conventional hospitalisation and planning ahead for acute episode and future decompensation.