Delirium is commonly observed in older patients who are admitted to the emergency department (ED). Previous systematic reviews have identified poor outcomes associated with delirium in surgical, intensive care and other hospital settings, yet none have specifically considered the ED. This systematic review aims to examine associations between older patients who present or develop delirium in the ED and adverse outcomes within the hospital and after discharge.

Searches will be conducted in MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. There will be no date or language restrictions. Key terms will include concepts related to delirium, the ED and older adults. Observational studies or non-intervention clinical studies will be included that compare outcomes in older patients (ie, ≥65 years) with and without delirium. Outcomes of interest will include length of hospital stay, non-home discharge (eg, nursing home/residential aged care facility), cognitive impairment, decreased physical function, mortality, readmission to hospital and quality of life measures. Two reviewers will independently screen the studies. Data extraction and quality assessment will be extracted by one reviewer and checked by a second reviewer, with any disagreements resolved by discussion or by a third reviewer. Where appropriate, data will be combined in a meta-analysis and a GRADE assessment will be made for each outcome. All methods will be guided by the Cochrane Handbook and the Centre for Reviews and Dissemination and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement as well as the recommendations set out by the Meta-analysis Of Observational Studies in Epidemiology group.

As this systematic review will use published data, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations.

CRD42024594975.

To develop a rapid screening tool for the identification of frailty in medical calls and other out-of-hospital acute care services.

Development study based on cross-sectional data. A set of potential items were developed based on existing frailty tools and other relevant literature by a panel with geriatric and primary care expertise. The items and the Clinical Frailty Scale (CFS) were administered on a convenience sample of older urgent care patients. Further development of the tool was based on statistical analyses of this data material and final discussions in the panel.

Urgent care centre in Norway, data collected between January and August 2022.

All patients ≥70 years were eligible for inclusion, with the exception of patients triaged to the highest urgency level and patients not able to answer questions with no next of kin present.

Potential items associated with frailty by CFS, measured by explained variance (adjusted R² values from linear regression analyses).

Nine potential items were developed and administered on 200 patients (59% female), of whom 48% were 70–79 years, 38% were 80–89 years and 14% were ≥90 years. The median CFS score was 4 (living with very mild frailty). Receiving help weekly, being homebound and using a walking aid were identified as strong indicators of frailty (adjusted R² values 59%, 48% and 43%, respectively). Together these three factors could explain 74% of the variation in CFS scores.

Receiving help weekly, being homebound and using a walking aid are strong indicators of frailty among urgent care patients. We developed a frailty screening tool for medical calls—FastFrail—consisting of three simple, binary questions (yes/no) on these aspects. We hypothesise that FastFrail can supplement traditional symptom-based triage and enable more accurate assessment of older adults calling for acute medical help. We intend to test the tool in clinical practice.