Geriatric Syndrome Prevalence Among Older Adults in the Emergency Department

Geriatric syndromes such as frailty, malnutrition, and dysphagia are significant risk factors for poor health outcomes and mortality. However, they are not routinely screened for in the emergency department (ED) and data on prevalence is limited. In this study, we aimed to assess the prevalence of geriatric syndromes amongst a population of older adults in the ED with diverse clinical presentations.

We prospectively enrolled a convenience sample of clinically stable older adults (≥60 years) presenting to the ED at a Midwest quaternary care center and completed validated geriatric syndrome assessments: frailty screening questionnaire (FSQ), sarcopenia questionnaire (SARC-F), short nutritional assessment questionnaire (SNAQ), eating assessment tool (EAT-10), functional oral intake scale (FOIS), xerostomia inventory (XI), and swallow quality of life (SwalQOL). The median score/interquartile range (IQR) and prevalence of abnormal scores for each tool was assessed.

We enrolled 100 older adults with a mean age of 72.7 years (60-69: n=41, 70-79: n=37, 80-89: n=20, 90+: n=2) of which 51% were female and 43% were discharged from the ED. FSQ (median [IQR]: 1 [1-2]) identified 20 frail and 56 pre-frail participants, resulting in 76% of participants being on the frailty spectrum. SARC-F (1.5 [0-4]) recognized 30 participants at risk for adverse outcomes from sarcopenia. According to SNAQ (0 [0-1]), one participant was moderately malnourished, and 11 participants were severely malnourished. EAT-10 (1 [0-3]) found 27 participants at risk for dysphagia and FOIS (7 [7-7]) identified 14 participants with some restrictions to the preparation or consistency of their diet. XI (20 [15-29]) found 39 participants had scores indicative of dry mouth. SwalQOL (92.9 [87.1-98.6]) identified 24 participants with clinically relevant swallowing problems. Nearly half of participants (49%) screened positive for xerostomia or dysphagia risk.

Frailty and oral/swallowing dysfunction were frequently observed in our population of older ED patients. These preliminary data indicate the need for larger studies examining prevalence and the clinical impact of screening for a spectrum of geriatric syndromes in the ED. Early identification could help flag patients in need of more intensive assessment and rehabilitative interventions to prevent downstream sequelae.