At-Point Clinical Frailty Scale as a Universal Risk Tool for Older Inpatients in Acute Hospital: A Cohort Study

Abstract

BackgroundWhile the Clinical Frailty Scale (CFS) has been extensively validated for predicting health outcomes in older adults, the role of the at-point CFS at the time of examination is unclear. We aimed to examine the ability of the at-point CFS for predicting clinical outcomes of older inpatients.MethodsAs a single-center and prospective cohort study, we enrolled 1,016 older adults who were 65 years or older and were admitted to one of 9 medical or surgical units from May 2021 to September 2021. The associations of the at-point CFS with outcomes of falls, delirium, pressure ulcers, 30-day unplanned readmission and/or emergency department (ED) visits, institutionalization, and a composite outcome were analyzed.ResultsIn the study population (n = 1,016), 26 patients had incident pressure ulcers, 6 patients had falls, 50 patients experienced delirium, and 13 patients died during hospitalization. Also, 37 patients experienced an ED visit and 22 patients had an unplanned readmission within 30 days after discharge. The composite outcome was 1.7% among patients with the CFS < 5 and 28.5% among patients with the CFS ≥ 5. The higher CFS was associated with an increased risk of a fall [odds ratio (OR) 1.74 (1.01–3.01)], pressure ulcers [OR 3.02 (2.15–4.23)], delirium [OR 2.72 (2.13–3.46)], 30-day readmission [OR 1.94 (1.44–2.62)], ED visit [OR 1.81 (1.47–2.23)], death [OR 3.27 (2.02–5.29)], and institutionalization after discharge [OR 1.88 (1.62–2.18)].ConclusionThe at-point CFS assessed in older inpatients can screen high-risk individuals who might experience adverse geriatric conditions and in-hospital outcomes.

Clinical Frailty Scale - frailty assessment and rehabilitation potential

“…By capturing both baseline and current function, the CFS empowers healthcare professionals to make more accurate prognoses, set more appropriate goals, and ultimately deliver more personalized and effective care for critically ill older patients. [16] Mounting evidence suggests that biological age, as reflected by frailty, can significantly predict mortality more than chronological age alone. [17,18] A cross-sectional observational study conducted in the respiratory ward of The Ottawa Hospital, a significant tertiary care academic center in Ottawa, Ontario, Canada, from December 2016 to June 2019, examined frailty among patients.…”

The Clinical Frailty Scale as a Risk Assessment Tool for Dysphagia in Older Inpatients: A Cross-Sectional Study

“…Future research should explore the implementation of CFS-based screening strategies in various healthcare settings and their impact on dysphagia management and frailty outcomes. 47 )…”

Geriatric Medicine in South Korea: A Stagnant Reality amidst an Aging Population

“…One of the local efforts may include the example of a tertiary hospital, which achieved committed to care excellence designation of the age-friendly health system in Korea, as demonstrated in a recent studies. 26 , 27 ) This example highlighted the effectiveness of the Clinical Frailty Scale (CFS), which evaluates the functional status of patients within 24 hours of acute hospital admission, in predicting geriatric outcomes like falls, pressure ulcers, and delirium, as well as general hospital outcomes including death, emergency visits, and readmissions. The tertiary has been integrating the at-point CFS into its electronic health records.…”

“…The tertiary has been integrating the at-point CFS into its electronic health records. 27 ) This integration is part of their initiative to adopt the 4M framework (matter, mentation, medication, and mobility) in developing an acute care pathway for older adults. This approach is aimed at providing efficient, person-centered geriatric interventions within their large-scale hospital environment.…”