PRISMA-7 (for frailty assessment) and SARC-F (for evaluation of sarcopenia risk) in predicting emergency department readmission and mortality

Background: Frailty scores can predict hospitalization and other related adversities. The frailty status determination is thus useful in clinical decisions regarding elderly patients. This study was aimed to evaluate the potential of PRISMA-7 (Program on Research for Integrating Services for the Maintenance of Autonomy 7 item question-naire) and SARC-F (A Simple Questionnaire to Rapidly Diagnose Sarcopenia) scores in predicting hospitalization following the emergency department (ED) admission, readmission at 1, 3 and 6 months, and mortality within 6-month follow-up period. Methods: A total of 150 patients of over 65 years age and presented to the ED in 6-month period were included in this prospective study. The patients’ SARC-F and PRISMA-7 scores were calculated at the first presentation to ED. Later, the same patients were evaluated via the electronic hospital system and called by phone. Their status was evaluated regarding the recurrent ED visits, hospitalization and mortality at 1, 3 and 6 months. Results: At the time of presentation, 72% patients had sarcopenia risk according to SARC-F score and 68.7% had frailty risk as per the PRISMA-7 score. ROC (Receiver Operating Characteristic) analysis exhibited the relationship between long-term mortality and PRISMA-7 and SARC-F scores. The best cut-off value of PRISMA-7 for predicting 6-month mortality was >3 in this study group. The best cut-off for long-term mortality was >7 in the ROC analysis of SARC-F score. Conclusions: PRISMA-7 and SARC-F were applicable at the initial presentation to ED as well as at the follow-up. Towards the end of study, positivity of single questionnaire predicted the readmission to ED, especially in the 1st month follow-up, while the positivity of both questionnaires predicted mortality in all the follow-ups. Clinical Trial Registration: NCT06525038.

Emergency department; Mortality; PRISMA-7; SARC-F

[1] Ellis B, Brousseau AA, Eagles D, Sinclair D, Melady D; CAEP Writing Group. Canadian association of emergency physicians position statement on care of older people in Canadian emergency departments: executive summary. Canadian Journal of Emergency Medicine. 2022; 24: 376–381.

[2] Gentili S, Emberti Gialloreti L, Riccardi F, Scarcella P, Liotta G. Predictors of emergency room access and not urgent emergency room access by the frail older adults. Frontiers in Public Health. 2021; 9: 721634.

[3] Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. Journal of the American Geriatrics Society. 2012; 60: 1487–1492.

[4] O’Caoimh R, Sezgin D, O’Donovan MR, Molloy DW, Clegg A, Rockwood K, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age and Ageing. 2021; 50: 96–104.

[5] Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet. 2013; 381: 752–762.

[6] Perazza LR, Avers D, Thompson LV. Measurement of frailty: tools and interpretation. Topics in Geriatric Rehabilitation. 2023; 39: 88–99.

[7] Yang ZC, Lin H, Jiang GH, Chu YH, Gao JH, Tong ZJ, et al. Frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis. The Journal of Nutrition, Health and Aging. 2023; 27: 487–495.

[8] Shebeshi DS, Dolja-Gore X, Byles J. Validation of hospital frailty risk score to predict hospital use in older people: evidence from the Australian longitudinal study on women’s health. Archives of Gerontology and Geriatrics. 2021; 92: 104282.

[9] Moloney E, O’Donovan MR, Sezgin D, Flanagan E, McGrath K, Timmons S, et al. Diagnostic accuracy of frailty screening instruments validated for use among older adults attending emergency departments: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2023; 20: 6280.

[10] Hoffmann S, Wiben A, Kruse M, Jacobsen KK, Lembeck MA, Holm EA. Predictive validity of PRISMA-7 as a screening instrument for frailty in a hospital setting. BMJ Open. 2020; 10: e038768.

[11] Cruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019; 393: 2636–2646.

[12] Ramirez E, Salas R, Bouzas C, Pastor R, Tur JA. Comparison between original and reviewed consensus of European working group on sarcopenia in older people: a probabilistic cross-sectional survey among community-dwelling older people. Gerontology. 2022; 68: 869–876.

[13] Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. Journal of Cachexia, Sarcopenia and Muscle. 2022; 13: 86–99.

[14] Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. Journal of the American Medical Directors Association. 2020; 21: 300–307.e2.

[15] Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Association between sarcopenia and cognitive impairment: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 2016; 17: 1164.e7–1164.e15.

[16] Shu X, Lin T, Wang H, Zhao Y, Jiang T, Peng X, et al. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta-analysis. Journal of Cachexia, Sarcopenia and Muscle. 2022; 13: 145–158.

[17] Williams GR, Al-Obaidi M, Dai C, Bhatia S, Giri S. SARC-F for screening of sarcopenia among older adults with cancer. Cancer. 2021; 127: 1469–1475.

[18] Bahat G, Erdoğan T, İlhan B. SARC-F and other screening tests for sarcopenia. Current Opinion in Clinical Nutrition & Metabolic Care. 2022; 25: 37–42.

[19] Okyar Baş A, Ceylan S, Güner M, Koca M, Balam Doğu B, Halil MG, et al. The validation of the Turkish version of the PRISMA-7 questionnaire; a case-finding instrument for detecting older adults living with frailty. European Journal of Geriatrics and Gerontology. 2023; 5: 52–58.

[20] Raîche M, Hébert R, Dubois MF. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Archives of Gerontology and Geriatrics. 2008; 47: 9–18.

[21] Bahat G, Yilmaz O, Kılıç C, Oren MM, Karan MA. Performance of SARC-F in regard to sarcopenia definitions, muscle mass and functional measures. The Journal of Nutrition, Health and Aging. 2018; 22: 898–903.

[22] Öztürk ZA, Türkbeyler İH, Abiyev A, Kul S, Edizer B, Yakaryılmaz FD, et al. Health-related quality of life and fall risk associated with age-related body composition changes; sarcopenia, obesity and sarcopenic obesity. Internal Medicine Journal. 2018; 48: 973–981.

[23] Bahat G, Ozkok S, Kilic C, Karan MA. SARC-F questionnaire detects frailty in older adults. The Journal of Nutrition, Health and Aging. 2021; 25: 448–453.

[24] Horney C, Schmader K, Sanders LL, Heflin M, Ragsdale L, McConnell E, et al. Health care utilization before and after an outpatient ED visit in older people. The American Journal of Emergency Medicine. 2012; 30: 135–142.

[25] Lampe D, Grosser J, Gensorowsky D, Witte J, Muth C, van den Akker M, et al. The relationship of continuity of care, polypharmacy and medication appropriateness: a systematic review of observational studies. Drugs & Aging. 2023; 40: 473–497.

[26] Gagliano M, Bula CJ, Seematter-Bagnoud L, Michalski-Monnerat C, Nguyen S, Carron PN, et al. Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization. BMC Geriatrics. 2023; 23: 642.

[27] Toker İ, Toker AK, Gökçek İ, Bülbül E. Retrospective analysis of the oldest-old patients who applied to the emergency department and their differences from the young-old and middle-old. Anatolian Journal of Emergency Medicine. 2023; 6: 20–24.

[28] O’Caoimh R, Costello M, Small C, Spooner L, Flannery A, O’Reilly L, et al. Comparison of frailty screening instruments in the emergency department. International Journal of Environmental Research and Public Health. 2019; 16: 3626.

[29] Yaman H, Ünal Z. The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Electronic Physician. 2018; 10: 7266–7272.

[30] Wou F, Gladman JR, Bradshaw L, Franklin M, Edmans J, Conroy SP. The predictive properties of frailty-rating scales in the acute medical unit. Age Ageing. 2013; 42: 776–781.

[31] O’Caoimh R, Gao Y, Svendrovski A, Healy E, O’Connell E, O’Keeffe G, et al. Screening for markers of frailty and perceived risk of adverse outcomes using the risk instrument for screening in the community (RISC). BMC Geriatrics. 2014; 14: 104.

[32] Jorgensen R, Brabrand M. Screening of the frail patient in the emergency department: a systematic review. European Journal of Internal Medicine. 2017; 45: 71–73.

[33] Aprahamian I, Aricó de Almeida GV, de Vasconcellos Romanin CF, Gomes Caldas T, Antunes Yoshitake NT, Bataglini L, et al. Frailty could predict death in older adults after admissionat emergency department? A 6-month prospective study from a middle-income country. The Journal of Nutrition, Health and Aging. 2019; 23: 641–647.

[34] Chen LK. Geriatric medical education in rapidly aging Asia. Aging Medicine and Healthcare. 2020; 11: 72–73.

[35] Sallehuddin H, Tan MP, Blundell A, Gordon A, Masud T. Development of a Malaysian undergraduate geriatric medicine curriculum. Aging Medicine and Healthcare. 2020; 11: 82–88.

[36] Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, et al. Undernutrition, sarcopenia, and frailty in fragility hip fracture: advanced strategies for improving clinical outcomes. Nutrients. 2020; 12: 3743.

[37] Walters S, Chan S, Goh L, Ong T, Sahota O. The prevalence of frailty in patients admitted to hospital with vertebral fragility fractures. Current Rheumatology Reviews. 2016; 12: 244–247.

[38] Ibrahim K, Mullee MA, Cox N, Russell C, Baxter M, Tilley S, et al. The feasibility and acceptability of assessing and managing sarcopenia and frailty among older people with upper limb fracture. Age Ageing. 2022; 51: afab252.

[39] Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012; 307: 182–192.