Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results

Abstract

F rail older adults have complex health and social care needs, and their functional abilities often decompensate in the face of acute illness. 1 Adverse events occur in the short term (e.g., increased length of stay or hospital complications) 2 and long term (e.g., readmission or death). 3,4 One approach to quantifying frailty-associated risk has been to consider the accumulation of health deficits, as operationalized in the Frailty Index. 5 This too is well-established in community samples; however, the extent to which these risk prediction tools can be translated in the acute setting where chronic and acute issues co-exist is unclear. Understanding how to measure accumulated deficits in frail patients presenting with acute illness would be an important step toward identifying patients who require targeted interventions such as those that maximize physical and cognitive function, 6 or patients with many active health conditions. Recent studies have used laboratory investigations combined as a frailty index (the FI-Laboratory) to identify incipient frailty states that might increase risk of adverse outcomes from clinically detectable frailty. 7-14 Adapted from animal studies, 15 the human FI-Laboratory was developed and used in communitydwelling populations 9,13,14,16-18 and in older adults in institutional RESEARCH Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

“…As with the severity of an acute illness, the degree of frailty matters. A recent report offers another insight into stratifying risk based on illness severity and frailty through the use of a frailty index based solely on routinely gathered laboratory data [ 5 ]. Here we extend some seminal work from Cambridge on the synergy between illness severity and frailty in increasing risk [ 6 ].…”

“…The increased risk experienced by frail older adults who are acutely ill comes not just from their frailty, but from the severity of their illness [ 7 , 13 , 14 ]. Both frailty and illness acuity can add information about risk [ 5 , 6 , 13 ]. Screening and assessment measures include formal acuity-based measures (e.g.…”

“…Typically ITU personnel administer the latter, even in the ED. Laboratory data assembled in a frailty index have also been employed as an illness acuity measure [ 5 ].…”

Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

“…With respect to the comprehensive geriatric assessment, the previous Barthel Index (BI) 15 and the cognitive status according to the Global Deterioration Scale were collected. 16 Frailty was assessed through the Rockwood Clinical Frailty Scale (CFS), taking into account the preexisting level of function and mobility, considering the usual cutoff points, from (1) very fit to (9) terminally ill. 17 The treatments used were grouped into (1) antibiotics (ie, ceftriaxone 2 g intravenous, azithromycin 500 mg or cefixime 400 mg), (2) fluid therapy, (3) enoxaparin, (4) hydroxychloroquine, and (5) inhalers.…”

A practical laboratory index to predict institutionalization and mortality – an 18-year population-based follow-up study

“…Subclinical deficits, taken together, even including deficits not individually related to death, have been shown to be related to adverse outcomes of aging and precede clinically evident health deficits [18][19][20][21]23]. A laboratory-based index has also been studied in acutely ill older adults admitted to hospital and could be useful also in an acute setting [24][25][26].…”