Comparison of 4 Frailty Measurements in Relation to Ageing, Physical Performance, and All-Cause Mortality.

Pain as an underrecognized geriatric syndrome in hospitalized older adults with major neurocognitive disorder: clinical correlates and outcomes.

Simple frailty assessments, such as the clinical frailty scale (CFS), are prognostic for worse outcomes in older adults with cancer and could support treatment decision-making. This interview study aims to explore clinicians' experiences of using simple frailty assessments in oncology, including the impacts on patient care and barriers and facilitators to successful implementation. Semi-structured individual interviews were conducted with clinicians at three UK sites that had implemented CFS screening in lung cancer clinics as part of a national pilot, to explore how frailty assessments are applied and are impacting care. Purposive sampling targeted a range of professionals involved in assessing frailty and making treatment decisions. Recordings were transcribed verbatim and analysed thematically. Ten clinicians participated, and four main themes were identified. 'Assessing fitness and frailty' explores the central role of performance status (PS), as well as its limitations, and what frailty assessments add. 'Scoring and interpreting CFS' describes the ease and relative yield of CFS use, particularly for patients with 'borderline' PS scores (e.g., PS 1-2 or 2-3), and the importance of contextual interpretation. 'Role of frailty and impacts of assessment' highlights how frailty assessments can enhance patient-centered care and support, and clinical and shared decision-making, with potential for streamlined care and system-level benefits. 'Barriers and facilitators to implementation' are described, including time, culture, guidance, and training, with recommendations provided. Assessing frailty has wide-ranging potential benefits for patients, oncology teams, and the wider system, but barriers must be overcome. Specific recommendations are provided to support the routine implementation of frailty assessments, which is a key step towards the benefits of frailty-informed care being realised at scale.

Abstract Background and Objectives We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. Methods This single‐center retrospective cohort study included patients aged ≥ 75 years with pathological stage I–III disease after R0 resection who underwent surgery within September 2012–2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease‐specific survival (DSS). Results Among 109 patients (median age: 78 [interquartile range, 76–82]; 65.1% male), the CFS 5–7 group ( n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1–4 group ( n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien–Dindo grade ≥ II. CFS 5–7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3‐year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. Conclusions CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long‐term outcomes in patients undergoing minimally invasive rectal cancer surgery.

ABSTRACT Background Sarcopenia is a geriatric syndrome characterized by progressive loss of skeletal muscle mass, strength, and function associated with aging. Studies evaluating the relationship between sarcopenia screening tools and elastography-based muscle quality measurements are quite limited. The main objective of this study was to evaluate the relationship between the SARC-F score and muscle elasticity in older adults. Methods This cross-sectional study included 140 adults aged ≥60 years attending geriatric or internal medicine outpatient clinics at a tertiary academic center. Sociodemographic characteristics, comorbidities, BMI, nutritional status (MNA-SF), frailty (Clinical Frailty Scale, FRAIL), and SARC-F scores were recorded. Rectus femoris thickness and elasticity were assessed using shear-wave elastography. Results The median age was 65 (60–91), and 62.9% (n = 88) were female. Positive SARC-F screen (SARC-F ≥ 4) was observed in 29.3% (n = 41). Participants at risk for sarcopenia were older (70 vs. 64 years, p < 0.001), more frail (CFS 5 vs. 3, p < 0.001), more malnourished (MNA-SF 10 vs. 13, p < 0.001), and had lower RF thickness (8.4 vs. 9.8 mm, p = 0.013) and lower muscle elasticity (10.9 vs. 14.6 kPa, p = 0.002). A weak negative correlation was found between SARC-F and RF elasticity (ρ = –0.315, p < 0.001). In the age- and sex-adjusted model, this association was no longer significant (p = 0.116). In multivariable stepwise regression, RF elasticity was not independently associated with SARC-F. Conclusions SARC-F is a practical screening tool for sarcopenia risk but may not adequately reflect muscle quality. These findings suggest that incorporating muscle quality assessments (e.g. shear-wave elastography) into sarcopenia screening may improve diagnostic accuracy and clinical management.

An increasing number of older adults living with frailty are undergoing surgery, yet scarce data on postoperative functional recovery, care needs after surgery, and extent of caregiver supports exist. To characterize older adults' and caregivers' recovery experiences in the first 6 months after surgery. This mixed-methods, multicenter, prospective nested cohort study included 17 hospitals in Canada. Participants included adults aged 65 years or older with a Clinical Frailty Scale score of 4 or more, who were recovering after major elective noncardiac surgery between March 16, 2021, and June 13, 2023, and their caregivers. Surveys included functional status via basic and instrumental activities of daily living, care needs, and care received or provided. A subset of patients and caregivers were invited to participate in semistructured interviews about their experiences and were analyzed using interpretive descriptive qualitative analysis. There were 289 individuals, including 204 older adults (mean [SD] age, 72.8 [5.6] years; 108 males [52.9%]) and 85 caregivers (mean [SD] age, 68.2 [12.2] years; 50 females [59.5%]), who participated in surveys, and 63 individuals (43 older adults and 20 caregivers) who participated in interviews. Older adults had a median (range) Clinical Frailty Score of 4 (3-6), indicating mild frailty, and 190 (93.1%) had 1 or more chronic diseases. Caregivers had a median (range) of 2 (0-8) chronic diseases, and 69 (82%) were spouses. Two months postoperatively, 129 of 203 older adults (64%) had more than 1 instrumental activities of daily living impairment, decreasing to 84 of 198 (42%) at 6 months after surgery; 68 of 203 (33%) had more than 1 activities of daily living impairment 2 months postoperatively, and this decreased to 38 of 198 (19%) at 6 months after surgery. Themes related to the recovery experiences were: (1) inadequate patient and caregiver education, preparation for surgery, and discharge; (2) the association of reduced independence with patient and caregivers; (3) the association of surgery with mental health; and (4) postoperative support from the health care team. All participants indicated that they wanted to be better prepared for surgery and discharge. In this mixed-methods cohort study, functional recovery in the first 6 months after noncardiac major elective surgery was associated with daily living impairment for older adults and their caregivers. Targeted interventions including preoperative education, caregiver-inclusive discharge planning (eg, wound-care teaching, how to recognize complications and what to do for support, and more rehabilitation), and early follow-up after discharge may optimize recovery experiences.

Clinical frailty is associated with reduced long-term survival after fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for thoracoabdominal aortic aneurysm. Patients who underwent F/BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS) was used to determine phenotypic frailty. Patients with a preoperative CFS of ≥4 (vulnerable) and a CFS of <4 were compared. We used χ2 and Fischer exact tests to compare patient demographics, anatomical and operative characteristics, and perioperative outcomes. Fine-Gray analysis was used to compare cause of death between groups. Long-term survival and reintervention were assessed with Kaplan-Meier and Cox regression analyses. We included 233 patients; 60 (25.8%) had a CFS of ≥4 and 173 (74.2%) had a CFS of <4. Patients with a CFS of ≥4 were more likely to have chronic obstructive pulmonary disease (53% vs 27%) and were treated for slightly larger aneurysms (72 mm vs 68 mm; P = .04). There were no differences in symptomatic presentation, aneurysm extent, or operative complexity between patient groups. Additionally, there were no differences in perioperative complications including 30-day mortality, stroke, and spinal cord ischemia. Patients with a CFS of ≥4 had an increased length of hospitalization (11.3 days vs 6.9 days; P < .01) and were less likely to return to preoperative functional status (62.7% vs 86.1%; P < .01). The 3-year all-cause and aortic-related mortality rates were 35.2% and 5.7%, respectively. Patients with a CFS of ≥4 had a lower survival at 1 year (74% vs 89%), 3 years (39% vs 73%), and 5 years (25% vs 56%), compared with patients with a CFS of <4 (P < .01). The most common causes of death among both groups were pulmonary comorbidities (14.0%), oncologic conditions (14.0%), cardiovascular comorbidities (11.2%), and procedure-related complications (11.2%). Patients with a CFS of ≥4 were more likely to die from aortic-related mortality (10.3% vs 5.9%; P = .02), pulmonary comorbidities (15.4 vs 13.2%; P = .04), systemic decline (7.7% vs 1.5%; P = .02), and infection (12.8% vs 7.4%; P = .03). Aortic-related mortality for the entire patient cohort was 2.2% and 5.7% at 1 year and 3 years, respectively. Aortic-related deaths among clinically frail patients were often due to an inability to tolerate further aortic operations (eg, arch repair), and secondary to follow-up nonadherence in patients with a CFS of <4. In an expanded cohort of patients, clinical frailty was associated with lower long-term survival and an increased risk for aortic-related mortality after F/BEVAR for the treatment of thoracoabdominal aortic aneurysms. Chronic disease burden is a primary driver of overall mortality, and clinically frail patients are more likely to die from pulmonary comorbidities, infection, and systemic decline. Phenotypic frailty assessment should be considered in preoperative assessment and patient counseling before F/BEVAR.

Frailty assessment in middle-aged and older patients with burn injuries, a prospective comparative study on the clinimetric properties of existing screening tools.

Feasibility of preoperative patient self-assessed frailty: a single-centre pilot study.

Clinical Frailty Scale Assessment Before Cardiac Surgery.

Home-based exercise reduces fall risk in older adults with mild cognitive impairment who have sustained a hip fracture: A 6-month randomized controlled trial.

Frailty, particularly chronic limb-threatening ischemia (CLTI), is a major health concern in patients with peripheral artery disease. CLTI onset can lead to increased frailty and impaired ability to perform daily activities. However, its in-hospital frailty progression in these patients remain poorly defined. This study aims to address this knowledge gap. We analyzed 841 CLTI patients (mean age, 75.8 years; 60.2% male) who underwent endovascular therapy (EVT) and were discharged alive from a multicenter registry. Frailty was assessed at admission and discharge using the Clinical Frailty Scale (CFS), categorized as non-frail (1-3), mildly frail (4-5), or advanced frail (6-9). Frailty progression was defined as a transition to a higher frailty category during hospitalization. The predictors of frailty progression during hospitalization were assessed using logistic regression analyses. Overall, 103 patients (12.2%) experienced frailty progression. Compared to those without progression, these patients had lower left ventricular ejection fraction (LVEF), lower hemoglobin and albumin levels, and more severe wounds. Independent predictors of frailty progression included LVEF ＜40% (odds ratio [OR], 2.02), hemoglobin ＜11 g/dL (OR 1.67), and Wound Grade 3 (OR 2.04). Within 2 years after discharge, the amputation-free survival rate was significantly lower in the progression group than in the non-progression group (42.6% vs. 56.0%; log-rank p = 0.008). The wound healing rate within 2 years after EVT was also significantly lower in the progression group than in the non-progression group (78.2% vs. 88.8%; log-rank p = 0.001). In-hospital frailty progression was observed in one of the eight patients with CLTI undergoing EVT. Frailty progression was linked to more severe clinical status and worse life and limb outcomes than cases without progression.

Renal cell carcinoma (RCC) primarily affects older adults who often present with frailty, increasing their risk of surgical complications and delayed recovery. Prehabilitation, incorporating exercise, nutrition, and psychological support, may improve postoperative outcomes. However, no studies have investigated prehabilitation prior to surgery for RCC. The aim is to assess whether a one-month multimodal prehabilitation program including geriatric interventions improves recovery in patients with frailty undergoing surgery for localized RCC≤7cm. 60 patients, aged ≥65, with a Clinical Frailty Scale (CFS) score of 3-6 are randomized 1:1 to standard care or prehabilitation involving home-based exercise, geriatric assessment with tailored interventions, and smoking cessation support. The primary outcome is change in Quality of Recovery-15 (QoR-15) 21days postoperatively. Secondary outcomes include changes in QoR-15, health-related quality of life (EQ-5D-5L) and physical performance (30-s chair-stand test, handgrip strength) assessed preoperatively, 1, 21 and 90days postoperatively. Postoperative complications will be evaluated using the Clavien-Dindo classification, alongside a cost-effectiveness analysis. Long-term outcomes include 1- and 5-year recurrence-free, cancer-specific, and overall survival. Pre-KiT explores if a pragmatic geriatric prehabilitation strategy is effective and feasible for older frail patients with RCC. The intervention is designed for easy implementation in clinical practice: administered by a single healthcare professional, requiring only one additional hospital visit, and consists of home-based exercises. This low-resource approach also aims to minimize financial costs, which is of importance for implementation possibilities. If successful, it could improve standard care and outcomes after surgery. ClinicalTrials.gov ID: NCT06745609. Prospectively registered December 12th, 2024.

The wound, ischemia and foot infection (WIfI) classification system has been widely adopted in chronic limb-threatening ischemia (CLTI) management. Primary aim was to prospectively investigate the association of WIfI stage with 1-year major amputation. Secondary aims included investigating associations of WIfI stage with baseline frailty, disability, and quality of life (QoL). Single-center prospective cohort study (NCT04027244). CLTI patients presenting between May 2019 and March 2022 were eligible. Frailty (clinical frailty scale), disability (Barthel index), and QoL (vascular QoL questionnaire; EQ-5D-5L) assessments were performed at baseline. Major amputation incidence for each WIfI stage was presented as percentages with 95% confidence intervals (CIs). Association of WIfI stage with 1-year major amputation was investigated using Fine-Gray competing risk analysis (death as competing risk), reported as subdistribution hazard ratios (SHRs) with 95% CI. A total of 363 patients were included. Increasing WIfI stage was associated with increasing frailty prevalence and frailty severity (P = 0.002), and greater disability (P < 0.001). QoL scores were similar for each WIfI stage. Major amputation incidence at 1-year was 2% (95% CI, 0%-11%) for WIfI stage 1, 7% (95% CI, 4%-14%) stage 2, 8% (95% CI, 4%-15%) stage 3, and 20% (95% CI, 13%-30%) for stage 4. Increasing WIfI stage was independently associated with 1-year major amputation (SHR, 1.99; 95% CI, 1.33-2.97; P = 0.001). WIfI clinical stage is strongly associated with major amputation at 1-year in patients with CLTI. Given its lack of association with QoL, WIfI stages may not reflect the full severity of symptoms experienced by patients.

Background Frailty is a dynamic state of vulnerability resulting from progressive functional decline and multimorbidity in patients with interstitial lung disease (ILD). The effect of lung transplantation (LTx) on frailty and its prognostic significance remains insufficiently understood. Methods This single-center cohort study aimed to characterize peri-transplant frailty trajectories, measured by the Clinical Frailty Scale (CFS), and determine their impact on long-term survival in patients with ILD undergoing LTx. CFS was assessed preoperatively, at 4-months and 5-years post-transplant. Patients were categorized as fit (CFS 1–3), vulnerable (CFS 4), or frail (CFS 5–9). Frailty change (ΔCFS) was classified as improved (ΔCFS ≤−1), unchanged (ΔCFS 0), or worsened (ΔCFS ≥+1). Survival was analyzed using Kaplan–Meier estimates and Cox proportional hazards models. Results The proportion of fit patients increased from 22.2% before to 87.5% 4 months, and 75.0% 5 years post-transplant. Frailty improved in 93.1%, remained unchanged in 2.8%, and worsened in 4.1% of patients. Median ΔCFS was −3 in frail, −1 in vulnerable, and 0 in pre-LTX fit patients. Prolonged ICU/hospital stay/ventilation was associated with reduced CFS recovery. Each one-point increase in ΔCFS was associated with a 1.78-fold higher mortality hazard (95%CI 1.34–2.35, p&lt;0.001). Compared to those with improvement, patients with worsened frailty had a 40.7-fold higher mortality hazard (95%CI 10.1–163.6, p&lt;0.001). Conclusions Peri-transplant CFS trajectory is associated with long-term survival in ILD, underscoring frailty as a modifiable risk factor and highlighting the need for systematic assessment and targeted interventions to optimize outcomes throughout the transplant course.

Despite advancements in surgical patient care, postoperative pulmonary complications (PPCs) following emergency abdominal surgery remain common and are linked to increased morbidity, mortality, and healthcare costs. This study aims to identify the incidence and risk factors of PPCs following major emergency abdominal surgery. This is a single-center observational study including patients undergoing major emergency abdominal surgery between January 1, 2021, and December 31, 2023, collecting pre-, intra-, and postoperative variables. The primary outcome was the occurrence of PPCs, and the secondary outcomes were risk factors for PPCs and 30-day mortality rates following PPCs. Multivariable logistic regression was used to identify perioperative risk factors associated with PPCs. The same analysis was used on a subgroup of patients with 'severe' PPCs. Of 1080 patients included in the study, 431 (39.9%) had at least one PPC, and 150 (13.9%) had at least one 'severe' PPC. Multivariable logistic regression identified several risk factors for developing PPCs: an increased ARISCAT score, a history of pulmonary disease, hypertension, a history of cerebral disease, increased Clinical Frailty Scale, preoperative admission to the intensive care unit, a CDC grade IV contaminated wound, intraoperative findings of perforated stomach or duodenal ulcer, need for subsequent reoperations, and protracted postoperative ileus. Patients with PPCs had a 30-day mortality rate of 21.0%, while those with 'severe' PPCs had a 30-day mortality rate of 46.3%. Several independent risk factors, beyond those already established, were associated with an increased risk of PPCs.

Oral frailty, a multidimensional decline in oral function involving chewing, swallowing, and oral behaviours, is a recognised precursor of dysphagia, malnutrition, and physical frailty. The Oral Frailty Index-8 (OFI-8) is a brief self-report screening tool for assessing oral frailty. This study's aim is to adapt the OFI-8 into Turkish (OFI-8-TR) and evaluate its psychometric properties among older adults. A cross-sectional study was conducted in 341 adults aged ≥ 65 years attending a geriatrics outpatient clinic. Internal consistency (KR-20), test-retest reliability (ICC), and construct validity (convergent, known-groups, and confirmatory factor analyses) were evaluated. Comparator measures included the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) scale, Clinical Frailty Scale (CFS), Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), and Mini Nutritional Assessment-Short Form (MNA-SF). The OFI-8-TR showed acceptable internal consistency (KR-20 = 0.62) and excellent test-retest reliability (ICC = 0.898). Confirmatory factor analysis supported a one-factor model (Comparative Fit Index (CFI) = 0.93, Goodness-of-Fit Index (GFI) = 0.95, adjusted Goodness-of-Fit Index (AGFI) = 0.91). Convergent validity was confirmed through strong correlations with the EAT-10 (r = 0.63) and FOIS (r = -0.62), and moderate correlations with FRAIL, CFS, and MNA-SF in the expected directions. Known-groups validity showed significantly higher scores among participants with malnutrition or risk of malnutrition. The OFI-8-TR is a valid and reliable instrument for assessing oral frailty and identifying swallowing-related and nutritional vulnerability in older adults. Its brevity and multidimensional structure make it a practical screening tool for routine geriatric assessments to support early identification of swallowing- and nutrition-related vulnerability.

Older adults with severe dysphagia who require percutaneous endoscopic gastrostomy (PEG) feeding and/or total parenteral nutrition (TPN) have substantial mortality risk, yet practical tools for prognostic stratification are limited. Whether age- and sex-adjusted adiposity estimation formulas (CUN-BAE, ECORE-BF, and the Deurenberg formula) can improve risk prediction for all-cause and pneumonia-related mortality in this setting remains unclear. This study is a secondary analysis of a previously established single-center Japanese retrospective cohort of 247 patients aged ≥50 years with severe dysphagia receiving percutaneous endoscopic gastrostomy (PEG) and/or total parenteral nutrition (TPN). Associations of adiposity estimators with all-cause and pneumonia-related mortality were evaluated using Kaplan-Meier analysis, Cox regression, restricted cubic splines (RCS), time-dependent ROC analysis, and the C-index. Incremental predictive value beyond the baseline model was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI), with sensitivity analyses including multiple imputation, exclusion of deaths within 30 days, and additional adjustment for the Clinical Frailty Scale. Across tertiles, Kaplan-Meier curves separated significantly for both all-cause and pneumonia-related mortality. In fully adjusted Cox models, the highest tertile was associated with higher all-cause mortality (HR 2.02-2.33) and markedly higher pneumonia-related mortality (HR 3.78-5.09) compared with the lowest tertile, with evidence of monotonic trends. Restricted cubic spline analyses supported largely linear dose-response relationships. Predictive discrimination improved over time; at 3 years, CUN-BAE and Deurenberg showed higher AUCs than ECORE-BF for both endpoints. Incremental analyses indicated added value for all-cause mortality with CUN-BAE and Deurenberg. Adiposity estimation formulas, particularly CUN-BAE and Deurenberg, provide clinically useful mortality risk stratification in severe dysphagia receiving PEG/TPN.

Frailty is increasingly recognized as been associated with adverse outcomes in older adults presenting to the emergency department (ED). Timely identification of frailty can inform clinical decision-making, guide resource allocation, and improve patient-centered care. This review summarizes findings from 33 studies published between 2019 and 2025, evaluating the diagnostic performance and predictive value of frailty screening tools in the ED. Tools assessed include the Clinical Frailty Scale (CFS), Identification of Seniors at Risk, PRISMA-7, interRAI ED Screener, electronic Frailty Index, and several hybrid or lab-based instruments. Most tools demonstrated moderate to high sensitivity but limited specificity and poor-to-fair overall accuracy in predicting outcomes such as hospitalization, ICU admission, length of stay, readmission, functional decline, and mortality. While the CFS remains the most widely used due to its simplicity and clinical familiarity, newer tools show promise in improving predictive accuracy through automation or integration with triage scores. However, no single instrument emerged as ideal. Feasibility, standardization, and implementation challenges, particularly in high-acuity ED environments, persist across all tools. This review highlights the need for ED-specific frailty strategies that balance rapid screening with comprehensive assessment.

Background/Objectives: Frailty is a major geriatric syndrome encountered in general practice. This study described the distribution of Clinical Frailty Scale (CFS) categories, care needs, and primary care utilization in a Vulnerable Elders Survey (VES-13)- screened high-risk cohort (VES-13 ≥ 3) from a single general practice. These prevalence estimates apply to this high-risk, single-centre primary care sample and should not be interpreted as estimates for unselected older primary care populations. Methods: We retrospectively reviewed medical records of 150 patients aged ≥ 60 years from a single primary care practice in Warsaw, Poland (1 August 2022-1 August 2023), restricted to those with VES-13 scores ≥ 3 (a routinely screened, high-risk subgroup). Frailty was assessed using the CFS. Results: The mean age of participants was 77 ± 8 years, and men accounted for 28% of the sample. Within this VES-13-selected high-risk cohort, 39 individuals (26%) were classified as non-frail (CFS 1-3), 72 (48%) as vulnerable (CFS 4), and 39 (26%) as frail (CFS ≥ 5). The need for assistance increased markedly with frailty severity, affecting 13% of non-frail individuals, 78% of vulnerable participants, and 100% of frail patients (p < 0.001). In the CFS ≥ 5 group, 46% required help several times per day and 8% required 24 h care. Patients with higher CFS scores used primary health care (PHC) services more frequently (mean 10 ± 5 visits per year in the non-frail group vs. 12 ± 6 in the vulnerable group and 17 ± 10 in the frail group; p < 0.001). Conclusions: In this single-practice, VES-13-selected high-risk primary care cohort, frailty (CFS ≥ 5) was observed in approximately one in four patients and vulnerability (CFS 4) in approximately one in two. Greater CFS severity was associated with higher care needs and more frequent primary care utilization.