Archives of Gerontology and Geriatrics 115 (2023) 105208 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Frailty and mortality: Utility of Frail-VIG index in ED short-stay units for older adults Marta Blázquez-Andión a, b, c, Josep Anton Montiel-Dacosta a, b, c, Miguel Rizzi-Bordigoni a, b, c, Belen Acosta-Mejuto b, c, Antoni Moliné-Pareja a, b, c, Josep Ris-Romeu b, c, d, Mireia Puig-Campmany a, b, c, * a Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain. b Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain c IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain d Urgent Care Process Hospital de la Santa Creu i Sant Pau. Sant Quintí 87, Barcelona 08025, Spain H I G H L I G H T S G R A P H I C A L A B S T R A C T • Frailty assessment is useful to individu­ alize diagnostic and therapeutic intensity. • Selecting the most appropriate frailty scale for each setting is highly relevant. • ED short-stay units should progressively implement frailty assessment. • Frail-VIG takes 7 min by trained staff and is strongly related to mortality. • Frail-VIG allows identifying a high-risk group of patients in ED short-stay units. A R T I C L E I N F O A B S T R A C T Keywords: Background: Frailty assessment allows the identification of patients at risk of death. The aim here was to study the Frailty ability of Frail-VIG Index (FI-VIG) in order to discriminate frailty groups of older adults and garner its correlation Aged with mortality in an Emergency-Department Short-Stay Unit (ED-SSU). Mortality Methods: Our observational, single-center, prospective study consecutively included patients over 65-years-old Clinical observation units Emergency medicine admitted between March 1, 2021, and April 30, 2021. Results: 302 patients were included (56 % women), mean age 83 ± 8 years, and 39.1 % of them had a functional disability whilst 16.5 % of them had dementia. A total of 174 patients (58 %) met the frailty criteria (FI-VIG ≥ 0.2): 111 (63.8 %) had mild frailty (FI-VIG 0.2–0.36), 52 (29.9 %) had moderate frailty (FI-VIG 0.36–0.55), and 11 (6.3 %) had advanced frailty (FI-VIG > 0.55). Mortality at 30 days, 6 months, and 1 year was analyzed: no frailty was 6.3 %, 10.8 %, and 12.5 %, respectively; mild frailty was 10.8 %, 22.5 %, and 22.5 %, respectively; moderate frailty was 25 %, 34.6 %, and 42.3 %, respectively; advanced frailty was 36.4 %, 54.5 %, and 3.6 %, respectively. This shows the significant differences between the groups (1-year mortality p < 0.001). Mild frailty vs. non-frail HR was 2.47 (95 %CI 1.12–5.46), moderate frailty vs. non-frail HR was 6.93 (95 %CI 3.16–15.23), and advanced frailty vs. non-frail HR was 11.29 (95 %CI 3.54–36.03). The mean test time was 7 min. * Corresponding author. E-mail address: mpuigc@santpau.cat (M. Puig-Campmany). https://doi.org/10.1016/j.archger.2023.105208 Received 21 July 2023; Received in revised form 9 September 2023; Accepted 19 September 2023 Available online 24 September 2023 0167-4943/© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). M. Blázquez-Andión et al. Archives of Gerontology and Geriatrics 115 (2023) 105208 Conclusions: There was a strong correlation between frailty degree and mortality at 1, 6, and 12 months. FI-VIG is fast and easy-to-use in this setting. It is routine implementation in ED-SSUs could enable early risk stratification. 1. Introduction The index consists of a 22-item deficit rating scale. As the authors have noted, the results describe a simple and quick tool (it is completed in Aging of the global population is increasing. In 2030, one in six 5–10 min) with an excellent discriminative and predictive capacity in people in the world will be over 65 years old. By 2050, two billion relation to mortality, and it performs a multidimensional assessment of people are expected to be older than 65 years, and the number of people the patient. over 80 will have tripled, reaching 426 million. (United Nations Popu­ The scale has subsequently been validated in the context of inter­ lation, Division; WHO. Health & Ageing, 2022) This has several impli­ mediate care or health care hospitals (Amblàs Novellas et al., 2022; cations for health and social care planning (Clegg et al., 2013). Amblàs-Novellas et al., 2017) as well as in the community setting with Frailty is the most complex expression of aging, and it is defined as a the same results. The authors keep it available in different languages and state of vulnerability and having a poor recovery rate following a free of charge at https://www.c3rg.com/index-fragil-vig. stressful event, which leads to an increased risk of delirium, disability, We think that this tool, which addresses more dimensions than other hospitalization, and death. (Clegg et al., 2013; Song, Mitnitski & Rock­ shorter tools recommended in ED, even though it requires a little more wood, 2010; Theou, Campbell, Malone & Rockwood, 2018) Frail pa­ time, is applicable in SSUs and can provide significant clinical value. The tients usually have high health care needs, (Blumenthal, Chernof, aim of our study is to analyze the utility of FI-VIG in a new scenario–– an Fulmer & Lumpkin, 2016) and are a growing group in the emergency ED-SSU. departments (ED) of hospitals. (Blumenthal, Chernof, Fulmer & Lump­ kin, 2016; Brousseau, Dent & Hubbard, 2018) 2. Materials and methods Frailty assessment is a keystone in geriatric care. It is common in older patients in both hospital wards and in EDs, with reported preva­ An observational, single-center, prospective cohort study was con­ lence rates between 21 and 62 %. (Ji, Michal Jazwinski & Kim, 2021; ducted in the SSU of the ED of the Hospital de la Santa Creu i Sant Pau Turner & Clegg, 2014; Boreskie et al., 2022; Amblàs-Novellas, Martori & (Barcelona, Spain), a tertiary and university urban hospital with a 550- Espaulella, 2018) In these two settings, frailty assessment is helpful for bed center. The SSU in this hospital has 36 beds, reporting to the ED, and identifying the needs of patients and providing specific, tailored, and it had 2243 admissions in 2021. effective care. (Simon, Jauslin, Bingisser & Nickel, 2022; Djärv, Castrén, The admission criteria in the SSU includes patients with a medical Martenson & Kurland, 2015; Fehlmann et al., 2022; Lucke, Mooijaart & pathology but with a stable condition that does not require close Heeren, 2022) A large number of tools have been proposed for frailty monitoring or invasive treatment, and the expected length of stay should assessment, each with different characteristics and limitations, and they be under 72 h. The most frequent diagnoses are heart failure, acute have all been validated in different healthcare setting. (Boreskie et al., chronic lung disease, urinary tract infection, respiratory infections, py­ 2022; Amblàs-Novellas, Martori & Espaulella, 2018) Despite this, frailty elonephritis, contusions, and non-surgical fractures of the elderly, assessment is not routinely performed in ED. (Elliott, Taub & Banerjee, among others. 2021; Kaeppeli, Rueegg & Dreher-Hummel, 2020; O’Caoimh et al., The study was approved by the Clinical Research Ethics Committee 2020; Jørgensen & Brabrand, 2017; Elliott, Phelps, Regen & Conroy, under sponsor code IIBSP-FRA-2020–74. The CEIC considered the 2017; Lewis, Dent & Alkhouri, 2019; O’Caoimh, Costello & Small, 2019) request for informed consent unnecessary because it was a registry of a Barriers include the lack of ED clinical guidelines on frailty as well as the validated scale and a non-interventional study. All patients admitted to unfeasibility of conducting the assessment in a stressed setting. the SSU were over 65 years old between March 1, 2021 and April 30, Short Stay Units (SSU) are emergency support hospitalization units, 2021, and they were consecutively included. Due to the characteristics which are useful for avoiding or reducing admissions. (Cosco, Best & of the study, and since it was an preliminary exploratory trial, with the Davis, 2021; Puig-Campmany, Blázquez-Andion, & Ris-Romeu, 2020; aim of obtaining an overview of the population and collecting baseline Alonso & Escudero, 2010) The admission criteria includes patients with data, a specific sample size was not established due to the lack of pre­ medical pathology, a clear diagnosis, or a stable condition that does not vious information or the novel nature of the research topic. Patients require close monitoring or invasive treatment, and with an expected were included consecutively for 2 months, which was considered a length of stay under 72 h. (Puig-Campmany, Blázquez-Andion, & reasonable period to obtain a representative sample based on the Ris-Romeu, 2020; Alonso & Escudero, 2010; Sánchez-Marcos, Jacob & availability and accessibility of the participants. Only patients admitted Llorens, 2022; González Armengol, Fernández Alonso & Martín for end-of-life care treatment were excluded from the study. After Sánchez, 2009) Over the years, the clinical profile of patients admitted admission, patients were followed up for one year. Follow-up was per­ to SSUs has changed significantly as a result of a change in the age de­ formed by consultation with the Shared Health Record of Catalonia mographic. (Sánchez-Marcos, Jacob & Llorens, 2022) Patients admitted (HC3) and comprised a telephone call to the patient or carer after 12 to an SSU are now older, and they have more comorbidities and poly­ months. There was no loss to follow-up. pharmacy. Frailty assessment in an SSU may now be useful, then, but it The research team consisted of two attending physicians from the is not routinely used, and, indeed, we did not find any work in which ED, the SSU chief nurse, and four nurses. FI-VIG support was used frailty has been explored in this setting. SSU-EDs are units with a heavy (available at https://en.c3rg.com/index-fragil-vig). After initial training workload, and there are no recommendations on the best tools to assess by the principal investigator, one of the nurses assessed IF-VIG within frailty in this particular setting. the first 24 h of admission, taking into account, as determined by the The Frail-VIG index (FI-VIG (VIG is the Spanish/Catalan abbrevia­ index, the patient’s situation in the 30 days prior to admission. tion for Comprehensive Geriatric Assessment)) is a frailty index (FI) Based on the FI-VIG https://en.c3rg.com/index-fragil-vig, patients developed by Amblàs et al. (C3RG, Chronicity Research Group of Central were categorized into non-frail (< 0.2), mild frailty (0.2–0.36), moder­ Catalonia), which offers the possibility of conducting a rapid CGA of ate frailty (0.36–0.55), and advanced frailty (> 0.55). individuals as well as calculating their grade of frailty, and which was The study variables were demographic and administrative data (date initially validated in a cohort of patients over 85 years of age in an Acute of birth, sex, date of admission to the short-stay unit, discharge date Geriatric Unit (UGA) (Amblàs-Novellas, Martori & Espaulella, 2018). from the unit, and reason for discharge) as well as clinical data 2 M. Blázquez-Andión et al. Archives of Gerontology and Geriatrics 115 (2023) 105208 (comorbidities, functional and cognitive status, social status, poly­ Table 1 pharmacy, and geriatric syndromes). Characteristics of patients admitted to the SSU. Following the methodology recommended by the authors of the Total population Non-frail Frail scale, the binary variables were scored as "0″ for absence and "1″ for N ¼ 128 (42 %) N ¼ 174 (58 %) presence of deficits. Money management, telephone use, and medication Mean age (years, mean ± SD) 80 ± 7 85 ± 7 management were assessed as instrumental activities of daily living. Women (n,%) 63 (20.9 %) 106 (35.1 %) Weight loss of more than 5 % in 6 months was assessed as a nutritional Men (n,%) 65 (21.5 %) 68 (22.5 %) marker; the presence of depressive syndrome, insomnia, and anxiety Barthel 86 ± 12 50 ± 14 Dementia (n,%) 3 (1 %) 47 (15.6 %) were assessed as emotional markers; and the presence of social vulner­ Dementia GDS > 6 (n,%) 0 6 (2 %) ability was assessed as a social marker. The presence of pain and dys­ e pnea were considered as symptoms that met the severity criteria. Non-fragility: Frail-VIG Index < 0.2; Fragility: Frail-VIG Index ≥ 0.2. GDS: global deterioration scale. Delirium, falls, ulcers, polypharmacy, and dysphagia were assessed as geriatric syndromes. Finally, the existence of chronic diseases was recorded as "1″, and in the case of advanced chronic disease, according to Table 2 the NECPAL Test (NECesidades PALiativas in Spanish, palliative needs), Patient’s characteristics. (Gómez-Batiste, Martínez & Blay, 2013) 2 points were assigned. In Total (N ¼ Frail (N ¼ No Frail (N ¼ p relation to ordinary variables, the Barthel index (Mahoney & Barthel, 302) 174) 128) 1965) was used in four categories according to the absence of depen­ Comorbidities N (%) dence or mild, moderate–severe, or severe dependence. Cognitive Depression 63 (20.9) 51 (29.3) 12 (9.4) 0.001 impairment was classified as 0 points with no impairment, 1 point was Cognitive 50 (16.6) 47 (27) 3 (2.3) 0.001 classed as mild/moderate impairment, and 2 points classed as impairment severe/very severe impairment. Mortality was monitored at admission, Delirium 21 (7) 21 (100) 0 0.001 at 1 month and 6 months, and then, finally, at 1 year through HC3 and Polipharmacy 230 (76.2) 156 (89.7) 74 (57.8) 0.001 Malnutrition 35 (11.6) 26 (14.9) 9 (7) 0,029 telephone calls. Cardiovascular 162 (53.6) 109 (62.6) 53 (41.5) 0.005 The result of the FI-VIG of each patient was not communicated to the disease healthcare team in order not to modify clinical practice or perform any Respiratory disease 100 (33.1) 71 (40.8) 29 (22.7) 0.013 intervention at this stage of the study. Neurological 53 (17.5) 46 (26.4) 7 (5.5) 0.001 disease Categorical variables were described as the frequency and the per­ Kidney disease 114 (37.7) 93 (53.4) 21 (16.4) 0.001 centage of the available data while quantitative variables were Digestive disease 34 (11,3) 29 (16.7) 5 (3.9) 0.001 described as the mean and standard deviation (SD). Descriptive statistics Neoplastic disease 25 (8.3) 18 (10.3) 7 (5.3) 0.179 of the variables analyzed were performed using SPSS. Statistical signif­ Barthel Index N (%) icance (95 % confidence interval/p0.05) for the variables between pa­ Mild dependence 71 (23.5) 60 (34.5) 11 (8.6) 0.001 Moderate 31 (10.3) 31 (17.8) 0 0.001 tients alive/dead was determined by means of mean contrasts (for dependence quantitative variables) and proportion contrasts (for qualitative vari­ Severe dependence 16 (5.3) 16 (5.3) 0 0.001 ables). For survival analysis, the log-rank test was used to compare survival curves according to the FI-VIG value and ROC curve analysis in order to determine the prognostic capacity of FI-VIG for 12-month %) had mild frailty, 52 (17.2 %) had moderate frailty, and 11 (3.6 %) mortality. had advanced frailty. 3. Results 3.3. Time of test execution 3.1. Descriptive analysis of the cohort • The mean running time of the index was 7 min per patient. • Of the 501 patients admitted to the SSU during the study period, 323 were over 65 years old. Of these, 21 had been admitted for end-of-life 3.4. Mortality analysis care and were excluded. A total of 302 patients were included in the study, whose mean age was 83 years (range 65–101), and 56 % of • Table 3 shows the differences in the percentage of mortality between them were women (n = 169). A total of 5 % of the patients (n = 15) the frailty groups. lived in a nursing home. • A total of 60.9 % of the patients had independence regarding the Table 3 basic activities of daily living (ADLs, n = 184). Mild–moderate Mortality of patients according to frailty degree. dependence for ADLs was observed in 23.5 % (n = 71), moder­ Non- Mild Moderate Advanced p ate–severe in 10.3 % of patients (n = 31), and absolute dependence frail frailty Frailty Frailty in 5.3 % (n = 16). Mild–moderate cognitive impairment GDS < 5 (n Women N (%) 63 (49.2 65 (58.6 33 (63.5 8 (72.7 %) 0.584 = 44) and moderate–severe cognitive impairment GDS > 6 (n = 6) %) %) %) accounted for 14.6 % of patients. Age 80 ± 7 84 ± 7 86 ± 7 87 ± 6 0.256 • In-hospital mortality of the cohort was 3 % (n = 9), and at 1 month it In-hospital 0 (0) 2 (1.8 %) 5 (9.6 %) 2 (18.2 %) 0.024 was 12.3 % (n = 37), at 6 months it was 20.6 % (n = 62), and at 1 Mortality year it was 23.2 % (n = 70). 30-day 8 (6.3 %) 12 (10.8 13 (25 %) 4 (36.4 %) 0.020 Mortality %) 6-month 13 (10.2 25 (22.5 18 (34.6 5 (54.5 %) 0.045 3.2. Frailty assessment Mortality %) %) %) 12-month 16 (12.5 25 (22.5 22 (42.3 7 (63.6 %) 0.003 • Characteristics of patients admitted to the SSU according to their Mortality %) %) %) frailty are presented in Table 1 and Table 2. Table 3. Based on the Frail-VIG index, patients were classified into non-frail (< • Of the 302 patients included, 128 (42.4 %) were categorized as non- 0.2), mild frailty (0.2–0.36), moderate frailty (0.36–0.55), and advanced frailty frail and 174 (57.6 %) were categorized as frail. Of these, 111 (36.8 (0.55–0.7). 3 M. Blázquez-Andión et al. Archives of Gerontology and Geriatrics 115 (2023) 105208 Fig. 1. Correlation between one-year survival and different degrees of frailty. One-year survival curve by frailty level. Different frailty groups present significant differences in mortality at one year (Hazard Ratio Mild Frailty vs. Non-Frail HR 2.47 CI95 % 1.12–5.46; Moderate Frailty vs Non-Frail 6.93 CI95 % 3.16–15.23); Advanced Frailty vs Non-Frail HR 11.29 CI95 % 3.54–36.03). • Fig. 1 shows the correlation between mortality at 1 year and FI-VIG Table 4 using the log-rank test, comparing the survival curves according to Hazard Ratio in relation to degrees of frailty. the value of FI-VIG, and discretized by the previously described intervals. Hazard Ratio Mild frailty vs No-Frail 2,47 IC95 % 1.12–5.46 3.5. Model usefulness Moderate frailty vs No-Frail 6,93 IC95 % 3.16–15.23 Advanced frailty vs No-Frail 11,29 IC95 % 3.54–36.03 • A ROC analysis was performed at 12 months to check the usefulness Table 4.Based on the Frail-VIG index, patients were classified into non-frail (< of the model in the population studied (Fig. 2). The ROC area under 0.2), mild frailty (0.2–0.36), moderate frailty (0.36–0.55), and advanced frailty the curve was 0.7120 (95 %CI 0.6423–0.7816). (0.55–0.7). • Hazard Ratio in relation to degrees of frailty is shown in Table 4. screening in SSU, with a similar performance to that already demon­ 4. Discussion strated in other settings. Although FI-VIG has been validated in other healthcare settings, it’s essential to validate its performance specifically Our work shows that FI-VIG is a reliable and accurate tool for frailty in the SSU setting to ensure its relevance and accuracy in this context. FI- VIG correlates frailty status with mortality, and our study shows that this correlation is also valid for an SSU setting. Moreover, the performance mean time was 7 min, which confirms that it is a feasible and easy-to-use scale in this unit. It is well known that frailty status leads to progressively higher mortalities during hospital admission, as well as at 30 days, 6 months, and 1 year after discharge. Although the patients admitted to the SSU showed different characteristics compared with the population in which the FI-VIG was initially validated, the results of this study demonstrate that the FI-VIG is also applicable in an SSU setting. Although the ROC curve results are slightly lower than those obtained in the pivotal study, in this patient cohort, FI-VIG value is accurate for predicting 12-month mortality. In our study, the mean cohort age was 83 years old, and almost 40 % of the patients had some degree of disability and 16.5 % had dementia. As in other SSUs in our country, the population is selected a priori by the criteria that determine the decision of admission to this unit, and the demographic characteristics of our cohort are similar to those reported in the recent literature. (Amblàs-Novellas, Murray & Espaulella, 2016) Through FI-VIG application, we were able to determine that 57.6 % of the patients in our SSU had some degree of frailty, given that most classified as mild (63.8 %) or moderately (29.9 %) frail. These data are relevant since we have not found similar studies describing frailty fea­ Fig. 2. ROC curve analysis to determine the prognostic capacity of FI-VIG for tures in an SSU. Despite being a previously selected population with an 12-month mortality. The Area under ROC curve was 0,71 (IC95 % 0,64–0,78). expected short hospital stay, our study revealed that in our SSU, there 4 M. Blázquez-Andión et al. Archives of Gerontology and Geriatrics 115 (2023) 105208 was a large group of frail individuals in whom FI-VIG performance could several dimensions, including chronic and oncologic diseases, and, thus, offer a great opportunity for tailored interventions. these diseases that can impact on mortality are included in the frailty Systematically measuring frailty is undoubtfully useful in patient assessment itself. Our study is limited to frailty and mortality evaluation, management (Amblàs Novellas et al., 2022). Different tools have been and the absence of any analysis of the length of stay or the discharge validated in different scenarios. The ED and the SSU are related settings, destination is an obvious limitation. However, the study does have but the population served has different demographic, emergency level several strengths: it was designed as a prospective study, we recruited a and disease characteristics. For this reason, ED recommendations about large number of patients, and, lastly, frailty assessment was performed frailty assessment cannot simply be extrapolated to SSU. We haven’t by a small and highly-trained research team. found any works that analyze or provide recommendations on frailty Future research is needed for improving the findings generaliz­ assessment in SSU. ability, with multi-center studies with larger and randomized samples, In the SSU, FI-VIG turned out to be an accurate tool that should be and including patients with varying degrees of frailty. Also, longitudinal incorporated in clinical practice. FI-VIG assigns to each patient a nu­ studies assessing the effectiveness of tailored interventions based on FI- merical score, allowing its categorization into different frailty degrees, VIG scores in improving patient outcomes and healthcare resource uti­ which, in turn, correlate well with mortality. Its implementation time, lization could provide valuable insights into the practical application of which may be too long for an emergency situation, is very well adapted the scale in clinical practice. to the SSU setting. In addition, as it is a multidimensional scale, it is able Finally, given the growing importance of frailty as an expanding to detect several deficits in frail patients that could be used as the base of public health problem, we believe that consensus documents on frailty a reglementary Comprehensive Geriatric Assessment (CGA) in a second assessment in ED and SSUs should be developed as soon as possible. The step. (Amblàs-Novellas, Martori & Espaulella, 2018; Sánchez-Marcos, stay of older adults in these units is a window of opportunity for frailty Jacob & Llorens, 2022). This would allow prompt patient referral to assessment, in order to deliver an integrated care. expert teams in order to initiate interventions focused on reversing or preventing secondary risks. By doing this, it improves the prevention of 5. Conclusions incidental geriatric syndromes during admission in frail individuals, as a specific care plan can be designed early (i.e., early mobilization, iden­ In conclusion, there is a strong correlation between the frailty degree tification and correct management of delirium, prevention of con­ measured with FI-VIG and mortality at 1, 6, and 12 months, and FI-VIG stipation and falls, careful pain management, avoidance of is a valid tool for systematic frailty identification in an ED SSU. It is a medication-related risks, and initiation of pharmaceutical care pro­ feasible and easy-to-use scale in this setting. grams, among others). Finally, by frailty stratification, FI-VIG offers the Its routine implementation in the SSU could enable early risk strat­ chance for tailored interventions and therapeutic intensity for these ification to detect vulnerable patients with specific needs. Future patients. (Van Dam, Hoogendijk & Mooijaart, 2021; Juanes, Garin & research is need to strengthen of the utility of FI-VIG in guiding in­ Mangues, 2018; Amblàs-Novellas, Murray & Espaulella, 2016) terventions and care plans for vulnerable patients in the SSU setting. The lack of clinical guidelines or consensus documents for frailty assessment in ED and SSU is a barrier. The busy environment, the short Funding length of stay, and the emergency situation are difficulties for frailty assessment, which, combined with the lack of clear evidence on useful This research was funded by the Hestia Chair in Integrated Social and tools and their impact, are delaying the implementation of frailty Health Care, 2020. assessment strategies in these settings. It is reasonable to assume that finding evidence on the best valid tool to use, will allow implementation Institutional review board statement of frailty assessment in the daily routine in this complex environments, improving patient’s care, and our work sheds light on this issue. The study was conducted in accordance with the Declaration of Although is a pilot study, and further, multicenter, and more robust Helsinki, and approved by the Ethics Committee Clinical Research Ethics studies are needed, our work suggest that in an SSU, where stays are Committee of the IIB Sant Pau, code IIBSP-FRA-2020–74. short and there is only a level degree of urgency, FI-VIG is adequate because it assesses several dimensions and has a reasonable test time. In Informed consent statement other settings as ED, other scales that require less time and training as Clinical Frailty Scale (CSF), are appropriate for establishing rapid as­ Patient consent was obtained in all cases, as requested by the Ethics sessments although it values fewer dimensions (Fehlmann et al., 2022; Committee. Lucke, Mooijaart & Heeren, 2022; Elliott, Taub & Banerjee, 2021; Kaeppeli, Rueegg & Dreher-Hummel, 2020). FI-VIG needs more time CRediT authorship contribution statement than CFS, but its execution time is reasonable and allows its inclusion in the SSU as a routine, involving a high value-added care. First, it could Marta Blázquez-Andión : Writing – original draft, Visualization, promote the prescription of simple interventions such as early mobili­ Validation, Methodology, Investigation, Formal analysis, Data curation. zation, identification and correct management of delirium, prevention Josep Anton Montiel-Dacosta : Writing – original draft, Validation, of constipation and falls, careful management of pain, prevention of Supervision, Methodology, Investigation, Funding acquisition, Formal medication-related risks that have an impact on patient health. Second, analysis, Data curation, Conceptualization. Miguel Rizzi-Bordigoni : more complex and more targeted interventions would be possible, Writing – original draft, Validation, Methodology, Formal analysis, Data opening up a wide scope of possibilities. curation. Belen Acosta-Mejuto : Writing – original draft, Validation, Our study has some notable limitations. It is an exploratory single- Supervision, Methodology, Investigation, Data curation. Antoni center study, and contains a low number of patients with advanced Moliné-Pareja : Writing – review & editing, Writing – original draft, frailty, probably due to the narrow admission criteria in an SSU. The Visualization, Validation, Supervision, Methodology, Formal analysis, consecutive inclusion of patients may introduce selection bias, although Data curation. Josep Ris-Romeu : Writing – review & editing, Writing – the number of frail patients is quite high, as the only exclusion criteria original draft, Visualization, Validation, Supervision, Software, Project was that patient was admitted for end-of-life care. No descriptive anal­ administration, Methodology, Investigation, Funding acquisition, ysis of associated diseases beyond the clinical data necessary to answer Conceptualization. Mireia Puig-Campmany : Writing – review & the items contained in FI-VIG, nor discharge destination, or length of editing, Writing – original draft, Visualization, Validation, Supervision, stay were performed. However, frailty assessment with FI-VIG includes Software, Project administration, Methodology, Investigation, Funding 5 M. Blázquez-Andión et al. Archives of Gerontology and Geriatrics 115 (2023) 105208 acquisition, Formal analysis, Conceptualization. Other contributors are Fehlmann, C. A., Nickel, C. H., Cino, E., Al-Najjar, Z., Langlois, N., & Eagles, D. (2022). Frailty assessment in emergency medicine using the clinical frailty scale: A scoping Elena Gonzalez, Rosario Fraile, David Figueroa, Sergio Herrera, J.Leo­ review. Internal and emergency medicine, 17, 2407–2418. https://doi.org/10.1007/ poldo Higa, Gastón Fernández, data curation. s11739-022-03042-5 Gómez-Batiste, X., Martínez, M., & Blay, C. (2013). Identifying patients with chronic Declaration of Competing Interest conditions in need of palliative care in the general population: Development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Supportive and Palliative Care, 3(3), 300–308. https://doi.org/10.1136/bmjspcare-2012-000211 The authors declare no conflict of interest. González Armengol, J. J., Fernández Alonso, C., Martín Sánchez, F. J., et al. (2009). Actividad de una unidad de corta estancia en urgencias de un hospital terciario: Cuatro años de experiencia. Emergencias, 21(2), 87–94. Acknowledgments Ji, L., Michal Jazwinski, S., & Kim, S (2021). Frailty and biological age. Annals of Geriatric Medicine and Research, 25(3), 141–149. https://doi.org/10.4235/agmr.21.0080 We thank Dr. Jordi Amblàs Novellas for his review of this manu­ Jørgensen, R., & Brabrand, M. (2017). Screening of the frail patient in the emergency department: A systematic review. 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