Abstract
BackgroundIncreasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians. The objective of this study is to determine whether the clinical frailty scale (CFS) can be used to identify patient baseline frailty status in the acute general medical setting when used by junior medical staff using information obtained on routine clinical assessment.MethodsThis was a prospective cohort study in an acute general medical unit. All patients aged 65 and over admitted to a general medical unit during August and September 2013 were eligible for the study. CFS score at baseline was documented by a member of the treating medical team. Demographic information and outcomes were obtained from medical records. The primary outcomes were functional decline and death within three months.ResultsFrailty was assessed in 95 % of 179 eligible patients. 45 % of patients experienced functional decline and 11 % died within three months. 40 % of patients were classified as vulnerable/mildly frail, and 41 % were moderately to severely frail. When patients in residential care were excluded, increasing frailty was associated with functional decline (p = 0.011). Increasing frailty was associated with increasing mortality within three months (p = 0.012).ConclusionsA high proportion of eligible patients had the frailty measure completed, demonstrating the acceptability of the CFS to clinicians. Despite lack of training for medical staff, increasing frailty was correlated with functional decline and mortality supporting the validity of the CFS as a frailty screening tool for clinicians.
Highlights
Increasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians
The frailty index based on a comprehensive geriatric assessment (FI-Comprehensive geriatric assessment (CGA)) at the time of hospital admission predicts increased risk of mortality and need for residential care [3, 8], but requires geriatrician input
This study demonstrates the feasibility of using the Clinical Frailty Scale in the acute general medical setting
Summary
Increasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians. Frailty can be used to identify older adults who are at increased risk of mortality and functional decline when they are hospitalized [2], but there is no consensus on the most appropriate way for non-geriatricians to identify frailty at the time of hospital admission [3]. The frailty index based on a comprehensive geriatric assessment (FI-CGA) at the time of hospital admission predicts increased risk of mortality and need for residential care [3, 8], but requires geriatrician input. Screening for frailty by non-geriatricians may identify patients most likely to benefit from a CGA [3].
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