Improving Function in Older Adults with Frailty Following an Emergency Department Presentation

Abstract Background The Active Recovery Team (ART) supports older adults to recover following an emergency department (ED) presentation by providing a responsive, next-day therapy intervention at home. The team comprises of a physiotherapist, occupational therapist, and therapy assistant. Older adults are referred to this service by the Frailty Intervention Team in the ED. Methods A retrospective review was conducted of patients discharged home from the ED with ART input between January 2024 and March 2025. Patient data included age, sex, frailty status (measured using the Clinical Frailty Scale), length of stay, and presenting complaint. Functional outcomes were assessed using the Functional Independence Measure (FIM) at initial ART assessment and on discharge from ART. Paired t-tests were used for statistical analysis. ED re-presentation and hospital admission rates were recorded at 72 hours, 7 days, and 30 days. Results A total of 118 patients were discharged from the ED with ART during the study period. All were contacted or had the first home visit on the next working day. The cohort was predominantly female (72%), with a mean age of 81 years. The average duration of ART input was 17 days (range: 3–70). Most patients (90%) had mild to moderate frailty (CFS 4–6); 5% were pre-frail (CFS 1–3), and 5% had severe frailty (CFS 7–9). Falls were the most common reason for ED attendance (72%), and 30% sustained a fracture. FIM scores significantly improved (p<0.001), with a mean increase of 3 points. ED re-presentation rates at 72 hours, 7 days, and 30 days were 1.7%, 2.5%, and 9.3%, respectively. Corresponding hospital admission rates were 1.7%, 1.7%, and 6.8%. Conclusion A responsive, therapy-led home intervention can effectively support older adults living with frailty to recover after an ED presentation. The ART model demonstrated significant functional improvement and low rates of representation and admission.