Association of the clinical frailty scale with hospital outcomes

Wallis, SJ; Wall, Jasmine; Biram, Richard; Romero-Ortuño, Román

doi:10.1093/qjmed/hcv066

Cited by 265 publications

(230 citation statements)

References 28 publications

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“…As we have shown, missing CFS data are more frequent in situations of very high acuity (including in critical care or surgical areas) or in medical areas when the LOS was short (eg, less than 72 hours). 8 We tried to address this bias by performing multiple imputation for missing data, which showed similar results.…”

Section: Discussionmentioning

confidence: 97%

“…14 The use of the CFS in admissions of people 75 years and older was introduced in our center in 2013 under a local Commissioning for Quality and Innovation (CQUIN) scheme. 8 The CQUIN required that all patients 75 years and older admitted to the hospital, via the ED, be screened for frailty using the CFS within 72 hours of admission. ○ Known HoD (in the database: no = 0; yes = 1) ○ ACS, without HoD (in the database: no = 0; yes = 1) ○ Neither HoD nor ACS • The cognitive CQUIN assessment does not intend to diagnose dementia in those who are not known to have it, but tries to separate the dementias that general practitioners (GPs) know from hospital-identified acute cognitive concerns that GPs may need to assess or investigate after discharge.…”

Section: Patients' Characteristicsmentioning

confidence: 99%

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The Association of Geriatric Syndromes with Hospital Outcomes

Romero-Ortuño

Forsyth

Wilson

et al. 2017

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 97%

Section: Patients' Characteristicsmentioning

confidence: 99%

The Association of Geriatric Syndromes with Hospital Outcomes

Romero-Ortuño

Forsyth

Wilson

et al. 2017

Journal of Hospital Medicine

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“…Studies exploring the predictive power of frailty scales for outcomes relevant to the UK acute medical care setting (Table 32) include prospective observational cohort studies (37,38,43) and secondary analysis of routinely collected large datasets, both clinical(178) and administrative (130,150). Our model performs uniformly across the clinical outcomes and is comparable in predictive power to frailty scores in the same setting.…”

Section: Risk Prediction Model Based On Frailty Syndromesmentioning

confidence: 96%

“…The studies were geographically distributed worldwide: 4 in the North America (41,163,166,167), Canada (36,(168)(169)(170)(171) There was variation in sample size, with the 3 large outliers unsurprisingly utilising secondary analysis of previous data (43,172,178) as methodology within single secondary care centres in the general internal medicine and elderly care setting. The observational studies were of relatively modest size ( Figure 3).…”

Section: General Features and Quality Assessmentmentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

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IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

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“…Frailty can be measured; the cumulative deficit model of frailty expresses frailty as a ratio of deficits present to a total list of deficits that have been pre-defined using a standard procedure. 4 This model maps well onto the Clinical Frailty Scale, 5 which is quick (<1 minute), simple and easy to use in urgent care settings. 6 Frailty identification is important at several levels.…”

Section: Introductionmentioning

confidence: 94%

Acute geriatrics at the front door

Conroy

Parker

2017

Clinical Medicine

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Older people with frailty and urgent care needs are major uses of health and social care services. Comprehensive geriatric assessment (CGA) is an evidence-based approach to improving their outcomes, as well as improving service outcomes. Geriatricians form a small proportion of the overall workforce and cannot address the population need alone, so all clinicians (doctors, nurses, therapists and so on) need to engage in delivering CGA as a process of care, underpinned by specifi c competencies -which can be developed. Delivery of this care pathway needs to be measured and improved as rigorously as campaigns like those for improving sepsis or eradicating methicillin-resistant Staphylococcus aureus . IntroductionFor many older people -in the UK at least -the emergency department (ED) is the main portal of entry to urgent care. In many cases, the older person's urgent care needs can be quickly assessed and managed within a short period of time (the 4-hour standard); in the UK, about one-third of people over the age of 85 years accessing EDs are able to return home directly. But for many others, a more detailed assessment and management plan is required, delivered in either observation wards in the ED (typically for people with an anticipated stay of less than 24 hours; variously termed clinical decision units, emergency decision units and other such acronyms) or an acute medical unit (for post-ED management of medical patients, initially for up to 72 hours) -staffed by acute physicians trained in acute assessment of a wide range of conditions. 1 While older people (65 or 75+ years) form a significant proportion of patients at all of these axes of care, and around two-thirds of all those receiving ongoing care in acute hospitals, there is a discrete subset of people aged 75+ who account for the bulk of bed days. Emerging data from the Nuffield Trust indicate about 20% of all those aged 75+ account for 85% of bed days and 85% of readmission or deaths within 90 days of an urgent care episode. It appears that this 20% resemble older people with frailty.Frailty is a distinctive late-life health state in which apparently minor stressor events are associated with adverse health outcomes. The two established international models are the ABSTRACT Acute geriatrics at the front door frailty phenotype 2 and the cumulative deficit model, 3 both of which have been validated in large population cohort studies. The models identify people at increased risk of a range of adverse outcomes, including dependency, institutionalisation and premature death. Frailty can be measured; the cumulative deficit model of frailty expresses frailty as a ratio of deficits present to a total list of deficits that have been pre-defined using a standard procedure. 4 This model maps well onto the Clinical Frailty Scale, 5 which is quick (<1 minute), simple and easy to use in urgent care settings. 6Frailty identification is important at several levels. Older people with frailty will often present with so-called nonspecific presentations, multiple comorbid...

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Association of the clinical frailty scale with hospital outcomes

Abstract: The CFS may help predict in-patient mortality and target specialist geriatric resources within the hospital. Usual hospital metrics such as mortality and LOS should take into account measurable patient complexity.

Cited by 265 publications

References 28 publications

The Association of Geriatric Syndromes with Hospital Outcomes

The Association of Geriatric Syndromes with Hospital Outcomes

Frailty Assessment in Acute Care

Acute geriatrics at the front door

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