**7. Decision-making**

adults, prognostic assessment methods are based on the clinical characteristics of severity of the index event. But the older adult cannot be seen under the traditional biomedical gaze that the unifactorial analysis of patients tends to. The complexity of the disease in the elderly is preferable to approach it from a biopsychosocial approach through multidimensional analysis, which identifies how the demographic, clinical, psychological, functional, and social factors influence the acute disease in the elderly and alter its forecast [19]. At the emergency environment, we need brief, simple, and validated tools that help us detect problems in different areas. However, currently there are few prognostic indices used in clinical practice that

Having clear prognostic variables to help the quick detection of the patient at high risk of this outcome helps to decide which patients should be considered for aggressive interventions, treatments with curative purposes, support treatments, or treatments only for palliative

Currently, there are models of structured triage in the emergency services, being the most prominent: the Australian model (Australasian Triage Scale (ATS)), the Canadian scale of triage and gravity for emergency services (Canadian Emergency Department Triage and Acuity Scale (CTAS), the Manchester Triage System (MTS), the Emergency Severity Index (ESI), and the Andorran model of triage (Model Andorra of Triage (MAT)); however, these are not suit-

When referring to the young and adult population, there are known instruments that try to predict the short-term prognosis of critical hospitalized patients, such as the APACHE III used in the intensive care units (ICU); the SUPPORT, to establish the 6-month prognosis of hospitalized patients both inside and outside the ICU; and more recently the short version of the EORTC QLQ-30 for use in palliative care. The drawback of these evaluations is that they overestimate age a priori as an element of risk, without considering that there are also "robust" elderly or with successful aging, in which the chronological age alone does not

The scales "Identification of Seniors at Risk" (ISAR) and the "Triage Risk Screening Tool" (TRST) have been published for use in the elderly, which allow assessing the risk of complica-

The prognosis of the diseases in geriatric patients is frequently influenced by the basal health condition of the elderly, which is determined by the nutritional status, the mental state, and the functional capacity (level of independence for the activities of daily life), variables that are not contemplated in the scales of habitual use in adults. In this sense, it has been shown that the deterioration of each of these areas can be an independent factor of mortality in the elderly.

The multidimensional geriatric assessment is an evaluation carried out by an interdisciplinary team to identify the problems and establish a care plan to improve the functionality and quality of life of the geriatric patient. It offers an integral and holistic view of the elderly adult patient, in which the clinical condition is evaluated, but psychological, functional, and social evaluation is also included. In fact, having knowledge of the instruments used in daily practice in geriatric care is extremely useful. Different scales and protocols are used and duly

tions at release of the service and classifying the degree of fragility [20].

include these variables typical of the elderly baseline condition.

purposes.

96 Gerontology

able for use in elderly patients.

weigh as a negative factor.

It is common to observe how some interventions are systematically denied to the elderly, arguing as the only reason age. This produces gross errors, since chronological age alone does not provide enough information to make the best decision. They are the multidimensional parameters that include basal functionality, comorbidities, and emotional-cognitive and social support, which together reflect biological aging and support the relevance or not of the proposed treatment [23].
