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Best Evidence Summary for the Management of Frailty in Elderly Patients in Emergency Department-Integrative Review
Meiling Yuan1, Haipeng Yang1, Yueguang Dai1
1Emergency Department, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
Aim:
To systematically search, evaluate and synthesize the most robust evidence regarding the management of frailty in elderly patients in the emergency department.
Design:
This study was conducted as an evidence summary, strictly adhering to the reporting standards for evidence summaries developed by the Center for Evidence-Based Nursing, Fudan University.
Data Sources:
UpToDate, BMJ Best Practice, JBI, National Guideline Clearing-house, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Yi Mai tong Guidelines Network, the Cochrane Library, PubMed, Web of Science, Embase, OVID, Sinomed, CNKI, Wan Fang database. The search was conducted from the inception of each database to June 2025.
Review Methods:
Evidence was selected using predefined eligibility criteria, critically appraised with AGREE II, AMSTAR 2, and Joanna Briggs Institute tools as appropriate, and synthesized using the JBI evidence classification and recommendation system. Study selection, appraisal and evidence extraction were undertaken independently by trained reviewers, with disagreements resolved through discussion or third-reviewer adjudication.
Results:
After rigorous screening and evaluation, 13 high-quality articles were identified, including 3 clinical guidelines, 1 randomized controlled trial (RCT), 2 clinical decision-making studies, 2 expert consensus documents, 2 cohort studies and 3 systematic reviews. Through collaborative in-depth deliberation, 34 evidence-based insights on emergency geriatric frailty management were extracted, synthesized, and categorized into 10 key themes.
Conclusion:
Healthcare professionals in emergency departments should prioritize geriatric frailty and select the highest-quality evidence tailored to clinical realities. This approach will enhance the standardization and systematicity of geriatric frailty management in emergency settings.
Impact:
Our study provides a structured approach (i.e., a stratified frailty assessment and intervention pathway, and a nurse-led multidisciplinary emergency frailty management model) and novel practical management methods (including an integrated screening-assessment-intervention-discharge continuous care protocol and an age-friendly emergency environment optimization strategy) for managing geriatric frailty in emergency settings, and promotes nursing services tailored to older adults. Collectively, these contributions aim to address the challenges of managing geriatric frailty in emergency departments and enhance the effectiveness of nursing interventions.
Reporting Method:
This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.
Trial Registration:
The registration number is 'ES20257380'.
For The Professional Field And Patient Care Implications:
The findings provide emergency nurses with actionable guidance for triage-based frailty screening, escalation to comprehensive assessment, medication reconciliation, mobility and nutrition support, caregiver engagement and structured discharge handover.
Patient Or Public Contribution:
No patients or members of the public were involved because this study synthesized previously published evidence.
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