Frailty assessment tools in the emergency department and their predictive value for clinical outcomes: review of the literature

Frailty is increasingly recognized as been associated with adverse outcomes in older adults presenting to the emergency department (ED). Timely identification of frailty can inform clinical decision-making, guide resource allocation, and improve patient-centered care. This review summarizes findings from 33 studies published between 2019 and 2025, evaluating the diagnostic performance and predictive value of frailty screening tools in the ED. Tools assessed include the Clinical Frailty Scale (CFS), Identification of Seniors at Risk, PRISMA-7, interRAI ED Screener, electronic Frailty Index, and several hybrid or lab-based instruments. Most tools demonstrated moderate to high sensitivity but limited specificity and poor-to-fair overall accuracy in predicting outcomes such as hospitalization, ICU admission, length of stay, readmission, functional decline, and mortality. While the CFS remains the most widely used due to its simplicity and clinical familiarity, newer tools show promise in improving predictive accuracy through automation or integration with triage scores. However, no single instrument emerged as ideal. Feasibility, standardization, and implementation challenges, particularly in high-acuity ED environments, persist across all tools. This review highlights the need for ED-specific frailty strategies that balance rapid screening with comprehensive assessment.