The association between clinical frailty and walking speed in older hospitalized medical patients: A retrospective observational study

Abstract

This study aims to further evaluate the use of the clinical frailty scale (CFS) by assessing its correlation with usual walking speed (UWS) in older medical inpatients. Methods Retrospective observational study in an English tertiary university hospital. We analysed all admission episodes of people admitted to the Department of Medicine for the Elderly wards during a 3-month period. We excluded those who died or had a CFS score of 9, indicating terminal illness. The CFS was recorded on admission and 6 meter UWS was measured on the day of hospital discharge. Other variables collected were: age, sex, the four item version of the Abbreviated Metal Test (AMT4), and the Emergency Department Modified Early Warning Score. Results There were 1022 patients admitted over the study period, of which 741 met inclusion criteria and had both CFS and walking speed data available. 570 were able to mobilise at least 6 meters. The median UWS was 0.33 (0.21-0.50) m/s. Logistic ordinal regression showed that lower CFS, being male and higher score in the AMT4 were associated with higher odds of being in a higher walking speed category (odds ratio for CFS after covariable adjustment: 0.57 (95% CI, 0.50 to 0.65). Conclusions We observed a strong association between higher admission CFS and lower discharge UWS. This association was not explained by variation in age, sex, presence of cognitive impairment or illness acuity and provides further evidence that the CFS maybe a valid measure of frailty in acute clinical settings.

How gait influences frailty models and health‐related outcomes in clinical‐based and population‐based studies: a systematic review

“…Badrawasi and colleagues 79 found that rapid pace gait speed was a significant frailty predictor. Hartley and colleagues 87 reported a strong association between higher admission Clinical Frailty Scale (CFS) 120 and lower discharge usual gait speed (OR: 0.57; 95% CI: 0.50–0.65), not explained by variation in age, sex, presence of cognitive impairment, or illness acuity, thus providing the CFS maybe a valid measure of frailty in clinical settings. Lee and colleagues 90 found that while use of either gait speed or grip strength alone was sensitive and specific as a proxy for the Fried frailty phenotype, the dual‐trait measure of gait speed with grip strength was accurate, precise, specific, and more sensitive than individual traits and other possible dual‐factor combinations.…”

“…Garcia‐Cifuentes and colleagues 85 reported that Colombian older adults who had low handgrip strength and gait speed had an increased risk to suffer of cognitive impairment, regardless of age, sex, education, or body mass index (OR: 2.76; 95% CI: 1.83–4.15). Hartley and colleagues 87 reported a relationship between the pre‐admission levels of frailty, as assessed by the CFS, which is based on clinical judgement, and objectively measured usual walking speed, assessed on the day of discharge from hospital. They observed a strong association between higher admission CFS and lower discharge usual walking speed, regardless of variation in age, sex, presence of cognitive impairment, or illness acuity.…”

Using Accelerometers to Measure Physical Activity in Older Patients Admitted to Hospital

“…ENMO values were used from the lower leg accelerometer to define whether or not a person was moving (when already determined to be standing according to the positional criteria). Our previous work has determined usual walking speeds in this population at the point of hospital discharge as 0.33 m/s (IQR 0.21–0.50 m/s), a very low speed compared to those reported in community based samples [ 34 ]. A cut-off of ENMO value of >13 milligravity units (mg) from the accelerometer on the lower leg was used to define a participant as “moving”.…”

Correction for potentially inappropriate prescribing can increase specificity when using drug prescriptions as an adjunct to diagnostic codes to assess comorbidities in older patients

“…In older patients, life expectancy and quality of life after an acute event depend not only on the event itself, but also on several factors related to their general conditions such as frailty [28], capability [29], drug burden [30] and comorbidities [5]. The latter have a well-known role in the outcome of patients with an acute neurological event [24,25,26].…”