Evaluation of clinical frailty screening in geriatric acute care

Abstract

Background: While frailty status is an attractive risk stratification tool, the evaluation of frailty in acute care can be challenging as some inpatients are unable to complete performance-based tests as part of frailty assessment and some tools may lack discriminative ability and categorize majority of cohorts as "frail". In this study, we evaluated the feasibility of frailty screening with the simple clinical frailty scale (CFS) by different clinicians, and its association with mortality and rehospitalization in a geriatric acute care setting. Methods:This study took place in Geriatric Medicine Department of a General Hospital in Singapore. We analysed records of 314 inpatients aged 70 years and older. At baseline, premorbid frailty was assessed using the CFS of the Canadian Study on Health and Aging. Demographic characteristics and other variables were retrieved from their medical records. Primary outcomes were mortality and rehospitalization during the 6-month follow-up. Survival analysis was used to compare the time to death and rehospitalization among CFS categories (1-4: nonfrail, 5-6: mild-moderate frail, and 7-8: severe frail).Results: CFS showed a high inter-rater reliability when used by different clinicians.In the Cox proportional hazard model controlling for age, gender, Charlson comorbidity index, modified severity of illness index, and discharge placements, severe frailty determined by CFS (HR = 2.09, 95% CI = 1.01-4.33, P = 0.047) and CFS scores (HR = 1.27, 95% CI = 1.05-1.53, P = 0.012) were significantly associated with higher mortality until 6-month postdischarge, but not rehospitalization. Conclusion:Frailty status determined by CFS adds to disease severity and comorbidity in predicting short-term mortality but not rehospitalization in older inpatients who received geriatric acute care in our setting. CFS is reliable and has the potential to be incorporated into routine screening to better identify, communicate, and address frailty in the acute settings.in poor restoration of homeostasis after a stressor event like hospitalization. The prevalence of frailty in community-dwelling older adults has been reported to be about 5%, 1 while in acute care settings, the prevalence of frailty among older patients is much higher (50%-80%). [2][3][4] In addition to severity of illness, frailty contributes independently to adverse hospitalization outcomes, 2,5-8 and can be important for prognosis and targeted interventions in acute settings.A number of approaches have been used in practice to operationalize frailty. 9,10 While the gold standard for assessment of frailty involves a comprehensive geriatric assessment (CGA) by a multidisciplinary team, it is a time-consuming complex process. 9,10 In an acute setting, inpatients are unable to complete performance-based tests as part of frailty assessment, and some tools may lack discriminative ability and categorize majority of cohorts as "frail". 2 It is increasingly recognized that different validated frailty assessment tools suit to different settings and pu...

Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

“…Our study included all patients aged 50 years and older. Furthermore, the discrepancy may be owing to a difference in the time frame of readmissions examined in our study (6 months) compared with the study by Chua et al 16 (12 months).…”

“…Our study results also indicated that frailty was associated with readmission for falls after index admission. In contrast, a study by Chua et al 16 indicated that frailty status determined using the CHSA CFS was not associated with a higher rate of rehospitalization within 6 months after hospital discharge. However, this discrepancy might be explained by the differences in inclusion and exclusion criteria between the studies.…”

“…However, this discrepancy might be explained by the differences in inclusion and exclusion criteria between the studies. Chua et al 16 excluded patients younger than 70 years, patients with acute functional decline whose frailty status had acutely changed, and patients who were transferred to their facilities from outside institutions. Our study included all patients aged 50 years and older.…”

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

“…The increased risk experienced by frail older adults who are acutely ill comes not just from their frailty, but from the severity of their illness [ 7 , 13 , 14 ]. Both frailty and illness acuity can add information about risk [ 5 , 6 , 13 ].…”

Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study

“…One instrument that has been validated in the inpatient setting is the Clinical Frailty Scale (CFS) (Figure 1), which is a simple face to face clinician assessment of frailty status [9]. The CFS can be rapidly scored within a clinical environment and has demonstrated high inter-rater reliability in a range of hospital settings, including the emergency department, intensive care and geriatric acute care [9][10][11][12]. The CFS has been found to predict clinical outcomes including mortality and dependence on health care in a range of settings [13][14][15][16][17].…”