Summary

Differences in characteristics and 30-day outcomes of older adults discharged from the Emergency Department According to the Functional Index eMergency (FIM)

Cesáreo Fernández Alonso¹, Francisco Javier Martín-Sánchez², Manuel Enrique Fuentes Ferrer³, Belén Rodríguez Miranda⁴, Martín Ruiz Grinspan⁵, Carmen del Arco Galán⁴, en representación de Registro ED-Frail-Madrid

Affiliation of the authors

¹Servicio de Geriatría, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain. ²Dirección Médica, Hospital Enfermera Isabel Zendal, IdISSC, Madrid, Spain. ³Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain. ⁴Servicio de Urgencias, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain. ⁵Servicio de Urgencias, Hospital Universitario del Henares, Coslada, Madrid, Spain.

DOI

Download Article

Quote

Fernández Alonso C, Martín-Sánchez FJ, Fuentes Ferrer ME, Rodríguez Miranda B, Ruiz Grinspan M, del Arco Galán C, en representación de Registro ED-Frail-Madrid. Differences in characteristics and 30-day outcomes of older adults discharged from the Emergency Department According to the Functional Index eMergency (FIM). Rev Esp Urg Emerg. 2026;5:16–23

Summary

OBJECTIVE. To identify distinct profiles of older adults discharged from hospital emergency departments (EDs) according to Functional Index eMergency (FIM) categories, based on patient characteristics and 30-day adverse outcomes (AOs).
MATERIAL AND METHODS. Secondary analysis of the FRAIL-ED-Madrid registry, which included patients older than 75 years discharged from 10 EDs in Madrid over 3 consecutive months between 2018 and 2019. Frailty screening variables and a geriatric assessment adapted for the ED were collected. The primary endpoint was the occurrence of any AO (ED revisit, hospitalization, functional decline, and/or death) within 30 days after discharge. Differences among FIM categories were analyzed.
RESULTS. A total of 619 patients (mean age 84 [SD, 6] years; 59 % women) were included. Of these, 233 (37.6 %) were classified as FIM-1, 191 (30.9 %) as FIM-2, 124 (20.0 %) as FIM-3, and 71 (11.5 %) as FIM-4. From FIM-1 to FIM-4, progressive increases were observed in frailty, age, dependency, comorbidity, and clinical complexity (P for trend < .001). Compared with FIM-1, higher FIM categories were independently associated with greater odds of experiencing an AO (FIM-2: adjusted OR, 2.56; 95 % CI, 1.51–4.33; P < .001; FIM-3: adjusted OR, 4.07; 95 % CI, 2.16–7.67; P < .001; FIM-4: adjusted OR, 5.01; 95 % CI, 2.85–8.79; P < .001).
CONCLUSIONS. The FIM distinguishes different profiles of older adults discharged from the ED. FIM-1 represents robust, low-risk patients; FIM-2 indicates frail but independent individuals at moderate risk; FIM-3 corresponds to chronically dependent, complex patients; and FIM-4 identifies dependent individuals with advanced chronicity and the highest risk at the end of life.