Background we investigated whether two frailty tools predicted mortality among emergency department (ED) patients referred to internal medicine and how the level of illness acuity influenced any association between frailty and mortality. Methods two tools, embedded in a Comprehensive Geriatric Assessment (CGA), were the clinical frailty scale (CFS) and a 57-item deficit accumulation frailty index (FI-CGA). Illness acuity was assessed using the Canadian Triage and Acuity Scale (CTAS). We examined all-cause 30-day and 6-month mortality and time to death. Results in 808 ED patients (mean age ± SD 80.8 ± 8.8, 54.4% female), the mean FI-CGA score was 0.44 ± 0.14, and the CFS was 5.6 ± 1.6. A minority (307; 38%) were classified as having low acuity (CTAS: 1–2). The 30-day mortality rate was 17%; this increased to 34% at 6 months. Compared to well patients with low acuity, the risk of 30-day mortality was 22.5 times (95% CI: 9.35–62.12) higher for severely frail patients with high acuity; 53% of people with very severe frailty (CFS = 8) and high acuity died within 30 days. When acuity was low, the risk for 30-day mortality was significantly higher only among those with very high levels of frailty (CFS 7–9, FI-CGA > 0.5). When acuity was high, even lower levels of frailty (CFS 5–6, FI-CGA 0.4–0.5) were associated with higher 30-day mortality. Conclusions across levels of frailty, higher acuity increased mortality risk. When acuity was low, the risk was significant only when the degree of frailty was high, whereas when acuity was high, even lower levels of frailty were associated with greater mortality risk.

Background the Clinical Frailty Scale (CFS) was originally developed to summarise a Comprehensive Geriatric Assessment and yield a care plan. Especially since COVID-19, the CFS is being used widely by health care professionals without training in frailty care as a resource allocation tool and for care rationing. CFS scoring by inexperienced raters might not always reflect expert judgement. For these raters, we developed a new classification tree to assist with routine CFS scoring. Here, we test that tree against clinical scoring. Objective/Methods we examined agreement between the CFS classification tree and CFS scoring by novice raters (clerks/residents), and the CFS classification tree and CFS scoring by experienced raters (geriatricians) in 115 older adults (mean age 78.0 ± 7.3; 47% females) from a single centre. Results the intraclass correlation coefficient (ICC) for the CFS classification tree was 0.833 (95% CI: 0.768–0.882) when compared with the geriatricians’ CFS scoring. In 93%, the classification tree rating was the same or differed by at most one level with the expert geriatrician ratings. The ICC was 0.805 (0.685–0.883) when CFS scores from the classification tree were compared with the clerk/resident scores; 88.5% of the ratings were the same or ±1 level. Conclusions a classification tree for scoring the CFS can help with reliable scoring by relatively inexperienced raters. Though an incomplete remedy, a classification tree is a useful support to decision-making and could be used to aid routine scoring of the CFS.

Background Clinically meaningful change (CMC) for frailty index (FI) scores is little studied. We estimated the CMC by associating changes in FI scores with changes in the Clinical Frailty Scale (CFS) in hospitalized patients. Methods The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network enrolled older adults (65+ years) admitted to hospital with acute respiratory illness (mean age = 79.6 ± 8.4 years; 52.7% female). Patients were assigned CFS and 39-item FI scores in-person at admission and via telephone at 1-month postdischarge. Baseline frailty state was assessed at admission using health status 2 weeks before admission. We classified those whose CFS scores remained unchanged (n = 1,534) or increased (n = 4,390) from baseline to hospital admission, and whose CFS scores remained unchanged (n = 1,565) or decreased (n = 2,546) from admission to postdischarge. For each group, the CMC was represented as the FI score change value that best predicted one level CFS change, having the largest Youden J value in comparison to no change. Results From baseline to admission, 74.1% increased CFS by ≥1 level. From admission to postdischarge, 61.9% decreased CFS by ≥1 levels. A change in FI score of 0.03 best predicted both one-level CFS increase (sensitivity = 70%; specificity = 69%) and decrease (sensitivity = 66%; specificity = 61%) in comparison to no change. Of those who changed CFS by ≥1 levels, 70.9% (baseline to admission) and 72.4% (admission to postdischarge) changed their FI score by at least 0.03. Conclusions A clinically meaningful change of 0.03 in the frailty index score holds promise as a benchmark for assessing the meaningfulness of frailty interventions.

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Our aim was to use the Comprehensive Geriatric Assessment (CGA) database to investigate whether the Clinical Frailty Scale (CFS) measuring the baseline state, and a Frailty Index (FI) based on a CGA (current state, with acute illness) can predict adverse outcomes in acutely ill Emergency Department (ED) patients. It contains CFS and FI scores on 1028 ED patients referred to internal medicine at the Halifax Infirmary between 2009-2019 (Mage 80.69 ± SD 8.28, range 57-103; 54.9% female). The mean scores were 0.44±0.14 (FI) and 5.58±1.66 (CFS). Most patients (72%) arrived via ambulance. The average length of stay was 27.0±20.5 hours. Overall, 22% were discharged home, and 63.5% had died by December 2017 with a mean survival time of 1.98±2.01 years. Controlling for age, sex, and Canadian Triage Acuity Score, the odds ratio (95% Confidence Interval) of being discharged home and the hazard ratio (95% Confidence Interval) for mortality was 0.94 (0.92-0.95) and 1.02 (1.02-1.03), respectively per 0.01-point increase in FI. For the CFS, using score ≤4 as the reference, the odds ratio and the hazard ratio were 0.70 (0.42-1.16) and 2.02 (1.51-2.69), respectively for the CFS 5 group, 0.47 (0.27-0.81) and 2.72 (2.05-3.61), respectively for the CFS 6 group, and 0.38 (0.21-0.70) and 4.67 (3.51-6.20), respectively for the CFS 7-9 group. Even controlling for acuity, both the CFS and the FI independently predict adverse outcomes in ED patients. These add prognostic information to the routinely collected ED assessments, and establish targets for care plan based on recovery to baseline.

BACKGROUND: The relationship between occupational physical activity and frailty is complex and understudied. OBJECTIVE: We explore whether moderate-vigorous physical activity (MVPA) in retirement and main lifetime occupation physical demands (OPD) are associated with frailty in retirement. METHODS: Retired adults aged 50 + who participated in waves 3-4 of the Survey of Health, Ageing and Retirement in Europe were included. We constructed a 65-item frailty index (FI; Wave 4). Linear regressions tested the independent associations between OPD (Wave 3) and retirement MVPA (Wave 4) with FI (B: 95% CI) controlling for occupation characteristics (Wave 3) and demographics (Wave 4). These models were repeated across country groups (Nordic; Mediterranean; Continental) and sexes. RESULTS: We included 8,411 adults (51.1% male) aged 72.4 years (SD 8.0). Frequent MVPA was consistently associated with lower FI (-0.09 : 0.10–-0.08, p < .001) while OPD was associated with higher FI (0.02 : 0.01-0.03, p < .001). The MVPA*OPD interaction (-0.02: -0.04–-0.00, p = .043) was weakly associated with FI, but did not explain additional model variance or was significant among any country group or sex. CONCLUSIONS: For a sample of European community-dwelling retirees, a physically demanding main lifetime occupation independently predicts worse frailty, even in individuals who are physically active in retirement.