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Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument: validating a short screening for frailty

Journal article
Authors Kajsa Eklund
Katarina Wilhelmson
Sten Landahl
Synneve Dahlin-Ivanoff
Published in BMC Emergency Medicine
Volume 16
Issue 27
ISSN 1471-227X
Publication year 2016
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Centre for Ageing and Health (Agecap)
Language en
Keywords frailty, screening, sensitivity, specificity
Subject categories Occupational Therapy


Background The identification of frail older persons in different health care settings is widely seen as an important step in improving the healthcare system. Screening at an emergency department (ED) should be handled in just a few minutes without the use of tests or measurements. The FRESH-screening was developed for this purpose. This study’s aim was to evaluate the FRESH-screening and its construct validity; also assessed were the sensitivity, specificity, and predictive values for frailty screening. Methods The study had a cross-sectional design. A total of 161 elderly people who sought care at the emergency department at Mölndal Hospital were included. Inclusion criteria were ages ≥80 years or ages 65–79 with at least one chronic disease and dependence in at least one daily living activity. Sensitivity, specificity, and predictive values were calculated to describe the accuracy of the FRESH-screening in identifying those with frailty, as assessed by eight frailty indicators. Sensitivity and specificity were both set at a minimum of 80%, and a percentage sum ≥150 of the sensitivity and positive prediction was considered a measure of excellent value. Result Both sensitivity and specificity were high (81% and 80%, respectively) when comparing the four questions of the FRESH-screening against the eight frailty indicators. The percentage sum of sensitivity and positive prediction was 173 (81% + 92%), thus exceeding the 150 cutoff.

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