Over the last decade, the proportion of emergency department (ED) visits by patients aged 65 and older has significantly increased, now accounting for more than 40% of all ED visits. Approximately 10% of these visits require critical interventions such as emergency surgery or admission to monitored units. Frailty, a clinical syndrome characterized by diminished physiological reserves and increased vulnerability to adverse health outcomes, is particularly common in this population and poses unique challenges for acute care management. Patients with frailty are more susceptible to complications during their ED and beyond visits, including delirium, unnecessary hospitalizations, and prolonged recovery times. Addressing these challenges requires a tailored approach to both the identification and management of frailty in emergency settings to improve outcomes and reduce the risks associated with acute care in this vulnerable population.

In this thesis, I began by reviewing the current use of the Clinical Frailty Scale (CFS) in the scientific literature in the emergency settings, identifying existing research gaps and potential areas for improvement. This comprehensive analysis allowed for the identification of areas where the CFS is being effectively applied and where further research or refinement is needed to enhance its utility in clinical practice. I then synthesized the evidence on the association between frailty and outcomes following emergency general surgery, a critical aspect of acute care. The findings demonstrated that frail patients tend to have worse outcomes, further emphasizing the importance of identifying frailty as early as possible. Recognizing the challenges of frailty assessment in the emergency department, the potential for prehospital frailty screening was explored. Specifically, the performance of paramedic assessments of frailty using the CFS was examined. The results showed that while the reliability of paramedic assessments was excellent, there is room for improvement in terms of validity, highlighting the need for further refinement in frailty identification at this stage of care. Finally, a survey of over 60 European emergency departments was conducted to evaluate their operational characteristics, revealing significant variability in the availability and structure of geriatric-dedicated services. This diversity emphasizes the need for standardized approaches to optimize care for older adults in emergency settings and opportunities for improving and expanding geriatric-specific resources across different healthcare systems.