Frailty / geriatric crisis
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Frailty reduces reserve across mobility, cognition, nutrition, and organ systems, so minor illness can trigger falls, delirium, dehydration, and abrupt loss of independence.
- Acute delirium, recurrent falls, inability to transfer, dehydration, pressure injury, medication error, or unsafe disposition requires escalation.
- Keep depression or social isolation in the differential; overlapping or concurrent illness remains possible.
- For frailty / geriatric crisis, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
Occult infectionTime-sensitive high-risk possibility
HPI
Clarify baseline cognition and mobility; acute change and timeline; falls, intake or medication change.
Signs & symptoms
Acute change or focal findings require active exclusion.
Focused exam
Assess attention, gait, transfers, hydration, skin, pain, and medication burden; Interpret current vital signs against baseline and repeat subtle abnormalities.
Brief pathophysiology
Occult infection may cause frailty / geriatric crisis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.
Temperature (°C)
Screen for medical causeFever or hypothermia suggests infection, exposure, or toxicity.
Blood glucose (mmol/L)
Check when indicatedGlucose disturbance can cause altered behaviour or weakness.
Heart rate (bpm)
Explain abnormalitiesTachycardia may reflect distress but should not be dismissed.
Blood pressure (mmHg)
Compare with baselineHypotension or severe hypertension warrants medical evaluation.
Front-load in the triage report
- Occult infection: Acute change or focal findings require active exclusion.
- Baseline cognition and mobility?
- Acute change and timeline?
FractureTime-sensitive high-risk possibility
HPI
Clarify acute change and timeline; falls, intake or medication change; goals of care.
Signs & symptoms
Acute change or focal findings require active exclusion.
Focused exam
Interpret current vital signs against baseline and repeat subtle abnormalities; Assess baseline and current cognition, gait, transfers, nutrition, hydration, skin, continence, medications, pain, and supports.
Brief pathophysiology
Fracture may cause frailty / geriatric crisis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Fracture: Acute change or focal findings require active exclusion.
- Acute change and timeline?
- Falls, intake or medication change?
StrokeTime-sensitive high-risk possibility
HPI
Clarify falls, intake or medication change; goals of care; caregiver and home supports.
Signs & symptoms
Acute change or focal findings require active exclusion.
Focused exam
Interpret current vital signs against baseline and repeat subtle abnormalities; Assess baseline and current cognition, gait, transfers, nutrition, hydration, skin, continence, medications, pain, and supports.
Brief pathophysiology
Stroke may cause frailty / geriatric crisis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Stroke is a clinical diagnosis supported by time course and neurologic findings. Blood pressure and glucose affect eligibility and mimics; normal vitals do not exclude stroke.
Blood pressure (mmHg)
Often elevatedHypertension is common in acute stroke; hypotension suggests another cause or poor perfusion.
Blood glucose (mmol/L)
Check every patientHypoglycemia can mimic focal deficit; hyperglycemia may accompany stress or diabetes.
Heart rate (bpm)
Assess rate / rhythmAn irregular rhythm may suggest atrial fibrillation but is not required.
Oxygen saturation (SpO₂)
Usually preservedHypoxemia requires correction and may indicate aspiration or another process.
Front-load in the triage report
- Stroke: Acute change or focal findings require active exclusion.
- Falls, intake or medication change?
- Goals of care?
Medication toxicityTime-sensitive high-risk possibility
HPI
Clarify goals of care; caregiver and home supports; ability to manage safely.
Signs & symptoms
Acute change or focal findings require active exclusion.
Focused exam
Interpret current vital signs against baseline and repeat subtle abnormalities; Assess baseline and current cognition, gait, transfers, nutrition, hydration, skin, continence, medications, pain, and supports.
Brief pathophysiology
Medication toxicity may cause frailty / geriatric crisis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.
Temperature (°C)
Screen for medical causeFever or hypothermia suggests infection, exposure, or toxicity.
Blood glucose (mmol/L)
Check when indicatedGlucose disturbance can cause altered behaviour or weakness.
Heart rate (bpm)
Explain abnormalitiesTachycardia may reflect distress but should not be dismissed.
Blood pressure (mmHg)
Compare with baselineHypotension or severe hypertension warrants medical evaluation.
Front-load in the triage report
- Medication toxicity: Acute change or focal findings require active exclusion.
- Goals of care?
- Caregiver and home supports?
Frailty decompensationCommon presentation pattern
HPI
Clarify baseline cognition and mobility; acute change and timeline; falls, intake or medication change.
Signs & symptoms
Small stressors may produce broad functional loss in a vulnerable patient.
Focused exam
Assess attention, gait, transfers, hydration, skin, pain, and medication burden; Interpret current vital signs against baseline and repeat subtle abnormalities.
Brief pathophysiology
Frailty decompensation may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.
Temperature (°C)
Screen for medical causeFever or hypothermia suggests infection, exposure, or toxicity.
Blood glucose (mmol/L)
Check when indicatedGlucose disturbance can cause altered behaviour or weakness.
Heart rate (bpm)
Explain abnormalitiesTachycardia may reflect distress but should not be dismissed.
Blood pressure (mmHg)
Compare with baselineHypotension or severe hypertension warrants medical evaluation.
Front-load in the triage report
- Small stressors may produce broad functional loss in a vulnerable patient.
- Baseline cognition and mobility?
- Acute change and timeline?
DepressionImportant alternative presentation
HPI
Clarify baseline cognition and mobility; acute change and timeline; falls, intake or medication change.
Signs & symptoms
May contribute but not explain abnormal physiology automatically.
Focused exam
Assess attention, gait, transfers, hydration, skin, pain, and medication burden; Interpret current vital signs against baseline and repeat subtle abnormalities.
Brief pathophysiology
Depression can resemble frailty / geriatric crisis through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.
Temperature (°C)
Screen for medical causeFever or hypothermia suggests infection, exposure, or toxicity.
Blood glucose (mmol/L)
Check when indicatedGlucose disturbance can cause altered behaviour or weakness.
Heart rate (bpm)
Explain abnormalitiesTachycardia may reflect distress but should not be dismissed.
Blood pressure (mmHg)
Compare with baselineHypotension or severe hypertension warrants medical evaluation.
Front-load in the triage report
- May contribute but not explain abnormal physiology automatically.
- Baseline cognition and mobility?
- Acute change and timeline?
Social isolationImportant alternative presentation
HPI
Clarify acute change and timeline; falls, intake or medication change; goals of care.
Signs & symptoms
May contribute but not explain abnormal physiology automatically.
Focused exam
Interpret current vital signs against baseline and repeat subtle abnormalities; Assess baseline and current cognition, gait, transfers, nutrition, hydration, skin, continence, medications, pain, and supports.
Brief pathophysiology
Social isolation can resemble frailty / geriatric crisis through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
There is no diagnostic vital-sign pattern for a behavioural, functional, or social presentation. Abnormal physiology should be explained and may indicate delirium, toxicity, infection, trauma, or another medical cause.
Temperature (°C)
Screen for medical causeFever or hypothermia suggests infection, exposure, or toxicity.
Blood glucose (mmol/L)
Check when indicatedGlucose disturbance can cause altered behaviour or weakness.
Heart rate (bpm)
Explain abnormalitiesTachycardia may reflect distress but should not be dismissed.
Blood pressure (mmHg)
Compare with baselineHypotension or severe hypertension warrants medical evaluation.
Front-load in the triage report
- May contribute but not explain abnormal physiology automatically.
- Acute change and timeline?
- Falls, intake or medication change?
Findings that should escalate concern
- Acute delirium, recurrent falls, inability to transfer, dehydration, pressure injury, medication error, or unsafe disposition requires escalation.
- Occult infection, fracture, stroke, or medication toxicity: Acute change or focal findings require active exclusion.
Medication recognition
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
- A02: Patient AssessmentBC Emergency Health Services Handbook
Official BCEHS clinical practice guidance for patient assessment.
- A13: Patient Care Planning for HandoverBC Emergency Health Services Handbook
Official BCEHS clinical practice guidance for patient care planning for handover.
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Multimorbidity: clinical assessment and managementNational Institute for Health and Care Excellence
Evidence-based assessment context for frailty, multimorbidity, treatment burden, and changes from baseline.
- Providing care for older adults in the Emergency Department: expert clinical recommendationsEuropean Geriatric Medicine · 2022
Frailty, baseline function, delirium, falls, polypharmacy, caregiver needs, and person-centred emergency care.