111 Adding Nuance to the Rockwood Clinical Frailty Scale

Abstract

Abstract Background The Rockwood Clinical Frailty Score (CFS) is a well validated tool for assessing frailty. However, there is a paucity of data in the literature demonstrating how severity of clinical frailty correlates with adverse outcomes. This gap in the literature limits the ability of physicians, who predominantly use measures of frailty in day-to-day practice such as CFS, to fully construe the implications of increasing frailty for patients in their care. Methods In this prospective cohort study, patients (n=186) aged >65 years admitted for unscheduled medical care to a district general hospital, were assigned a clinical frailty score within 24 hours of admission. Patients were then followed up for 12 months and assessed in terms of mortality, discharge to institutional care, length of hospital admission, polypharmacy and re-admission rate. Results This study found significant differences between frail and non-frail populations in terms of adverse patient outcomes including mortality, length of hospital admission, polypharmacy, co-morbidity and re-admission rates. Of greater importance still, this study found that increasing risk of adverse outcomes correlated with increasing CFS. For CFS ≤4, 5, 6, 7, 8, 9 12-month mortality rates were 7.55%, 28.6%, 31.4%, 37.14%, 87.5% and 100% respectively. For CFS ≤4, 5, 6, 7, 8, 9 rates of discharge to institutional care were 1.88%, 6.12%, 34.3%, 41.66%, 50% and 40% respectively. Conclusion These results are important as they begin to help physicians form a more nuanced interpretation of CFS. With growing emphasis on individualising patient care, binary categorisation of patients into ‘frail’ and ‘non-frail’ groups is felt to be an increasingly inadequate way of viewing frailty. This study adds information to the discourse which helps both physicians and patients to make more informed decisions regarding their on-going medical care. Larger prospective cohort studies will now be required to understand correlation between severity of frailty and patient outcomes.