Research paper|Articles in Press

Older women's view on frailty and an Emergency Department evidence-based Frailty Intervention Team (FIT) program: An evaluation using the Reach, Effectiveness, Adoption, Implementation, Maintenance RE-AIM framework

Published:February 23, 2023DOI:



      Older women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a ‘Frailty Intervention Team’ (FIT) program.


      A prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention.


      Over three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified.


      The FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australasian Emergency Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Australian Institute of Health and Welfare (AIHW). Emergency department care 2015–16: Australian hospital statistics. Canberra: AIHW; 2016.

      2. Australian Institute of Health and Welfare (AIHW). Emergency department care 2019–20: Australian hospital statistics. Canberra: AIHW; 2020.

        • Hubbard R.E.
        • Rockwood K.
        Frailty in older women.
        Maturitas. 2011; 69: 203-207
        • Arendts G.
        • Burkett E.
        • Hullick C.
        • Carpenter C.R.
        • Nagaraj G.
        • Visvanathan R.
        Frailty, thy name is….
        Emerg Med Aust. 2017; 29: 712-716
        • Ellis G.
        • Marshall T.
        • Ritchie C.
        Comprehensive geriatric assessment in the Emergency Department.
        Clin Inter Aging. 2014; 9: 2033-2043
        • Rockwood K.
        • Theou O.
        Using the clinical frailty scale in allocating scarce health care resources.
        Can Geriatr J. 2020; 23: 210-215
        • Glasgow R.E.
        • Harden S.M.
        • Gaglio B.
        • Rabin B.
        • Smith M.L.
        • Porter G.C.
        • et al.
        RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review.
        Front Public Health. 2019; 7: 1-9
        • Glasgow R.E.
        • Vogt T.M.
        • Boles S.M.
        Evaluating the public health impact of health promotion interventions: the RE-AIM framework.
        Am J Public Health. 1999; 89: 1322-1327
        • Dent E.
        • Lien C.
        • Lim W.S.
        • Wong W.C.
        • Wong C.H.
        • Ng T.P.
        • et al.
        The Asia-Pacific Clinical Practice Guidelines for the management of frailty.
        J Am Med Dir Assoc. 2017; 18: 564-575
      3. The Royal Australian College of General Practitioners (RACGP). RACGP aged care clinical guide (Silver Book) [Internet]; 2019. Available from: 〈〉.

      4. Australasian College of Emergency Medicine (ACEM). Care of older persons in the Emergency Department [Internet]; 2020. Available from: 〈–492a-9e66–47b7896e5c70/Policy_on_the_Care_of_Older_Persons_in_the_ED〉.

        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Tiedemann A.
        • Sherrington C.
        • Orr T.
        • Hallen J.
        • Lewis D.
        • Kelly A.
        • et al.
        Identifying older people at high risk of future falls: development and validation of a screening tool for use in Emergency Departments.
        EMJ. 2013; 30: 918-922
        • Cournan M.
        Use of the Functional Independence Measure for outcomes measurement in acute inpatient rehabilitation.
        Rehab Nurs. 2011; 36: 111-117
        • Hall K.M.
        • Hamilton B.B.
        • Gordon W.A.
        • Zasler N.D.
        Characteristics and comparisons of functional assessment indices: disability rating scale, functional independence measure, and functional assessment measure.
        J Head Trauma Rehabil. 1993; 8: 60-74
        • Schoenborn N.L.
        • Van Pilsum Rasmussen S.E.
        • Xue Q.L.
        • Walston J.D.
        • McAdams-Demarco M.A.
        • Segev D.L.
        • et al.
        Older adults' perceptions and informational needs regarding frailty.
        BMC Geriatr. 2018; 18: 46
        • Gwyther H.
        • Shaw R.
        • Dauden E.A.
        • D’Avanzo B.
        • Kurpas D.
        • Bujnowska-Fedak M.
        • et al.
        Understanding frailty: a qualitative study of European healthcare policy-makers’ approaches to frailty screening and management.
        BMJ Open. 2018; 8e018653
        • Chong E.
        • Zhu B.
        • Ng S.H.X.
        • Tan H.
        • Goh E.F.
        • Molina J.D.C.
        • et al.
        Emergency Department interventions for frailty (EDIFY): improving functional outcomes in older persons at the emergency department through a multicomponent frailty intervention.
        Age Ageing. 2022; 51
        • McCusker J.
        • Cardin S.
        • Bellavance F.
        • Belzile E.
        Return to the emergency department among elders: patterns and predictors.
        Acad Emerg Med. 2000; 7: 249-259
        • Pereira L.
        • Choquet C.
        • Perozziello A.
        • Wargon M.
        • Juillien G.
        • Colosi L.
        • et al.
        Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study.
        PLoS One. 2015; 10e0123803
        • Trenholm J.R.
        • Warner D.G.
        • Eagles D.D.
        Occupational therapy in the Emergency Department: patient frailty and unscheduled return visits.
        Can J Occup Ther. 2021; 88: 395-406
        • Warmoth K.
        • Lang I.A.
        • Phoenix C.
        • Abraham C.
        • Andrew M.K.
        • Hubbard R.E.
        • et al.
        'Thinking you're old and frail': a qualitative study of frailty in older adults.
        Ageing Soc. 2016; 36: 1483-1500
        • Blomaard L.C.
        • Olthof M.
        • Meuleman Y.
        • de Groot B.
        • Gussekloo J.
        • Mooijaart S.P.
        Experiences with and attitudes towards geriatric screening among older emergency department patients: a qualitative study.
        BMC Geriatr. 2021; 21: 1-10
        • Canbolat Seyman C.
        • Sara Y.
        The opinions of Turkish older adults related to frailty: a qualitative study.
        Orthop Nurs. 2021; 40: 375-382
        • Pan E.
        • Bloomfield K.
        • Boyd M.
        Resilience, not frailty: a qualitative study of the perceptions of older adults towards “frailty”.
        Int J Older People Nurs. 2019; 14e12261
        • Grenier A.
        • Hanley J.
        Older women and ‘frailty’ aged, gendered and embodied resistance.
        Curr Sociol. 2007; 55: 211-228
        • Puts M.T.
        • Shekary N.
        • Widdershoven G.
        • Heldens J.
        • Deeg D.J.
        The meaning of frailty according to Dutch older frail and non-frail persons.
        J Aging Stud. 2009; 23: 258-266
        • Van Damme J.
        • Neiterman E.
        • Oremus M.
        • Lemmon K.
        • Stolee P.
        Perspectives of older adults, caregivers, and healthcare providers on frailty screening: a qualitative study.
        BMC Geriatr. 2020; 20: 1-12
        • D’Avanzo B.
        • Shaw R.
        • Riva S.
        • Apostolo J.
        • Bobrowicz-Campos E.
        • Kurpas D.
        • et al.
        Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: a meta-synthesis of qualitative evidence.
        PLoS One. 2017; 12e0180127
        • Fillit H.
        • Butler R.N.
        The frailty identity crisis.
        J Am Geriatr Soc. 2009; 57: 348-352
        • Kolk D.
        • Kruiswijk A.F.
        • MacNeil-Vroomen J.L.
        • Ridderikhof M.L.
        • Buurman B.M.
        Older patients' perspectives on factors contributing to frequent visits to the Emergency Department: a qualitative interview study.
        BMC Public Health. 2021; 21: 1-10
        • Lilleheie I.
        • Debesay J.
        • Bye A.
        • Bergland A.
        Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary.
        BMJ Open. 2019; 9e025789