Aims and Objectives Emergency care systems were designed for people with single, specific problems. Reconfiguration is required to deliver comprehensive care for those with multiple, complex problems. These are typically older people living with frailty, whose service use remains poorly understood. This study primarily determined frailty prevalence among older emergency care users across Europe. Service characteristics and concordance with frailty screening were also examined.

Method and Design A cross-sectional flash mob study collected observational data over a 24-hour period at sites identified through interest groups and networks. Consecutive data were collected for all emergency care attenders aged 65+, with a subset of sites’ electronic records observing all aged 18+. Variables included age, Clinical Frailty Scale (CFS), vital signs, and disposition. Frailty prevalence was determined. Sites were surveyed on structure and function of acute frailty services. A subset of sites’ frailty data from consecutive observation and an earlier ‘normal day’ were compared.

Results and Conclusion 62 sites in 14 countries collected data for 5785 individuals, of whom 3479 were aged 65+. 40% (national range, 26-51%) of older people had CFS 5+. Among 22 sites with data for all adults, older people living with frailty comprised 14% attendances. In normal practice 69% sites used while 38% mandated CFS, and 24% mandated additional risk screening such as for delirium. 10% had specialist acute frailty services available outside of daytime hours. A minority (5) sites routinely recorded CFS in retrievable electronic format; there was systematic missingness with entries more frequently omitted in non-white or less unwell people.

40% of older people using European emergency care had CFS 5+. Optimised services for those with frailty remain uncommon, and study of individuals’ risk and outcomes using routine data may have limited validity. Redoubled efforts are warranted to optimise service models, educate a multidisciplinary workforce, and deliver representative research.