Enhancing Communication in End‐of‐Life Care: A Clinical Tool Translating Between the Clinical Frailty Scale and the Palliative Performance Scale

Grossman, Daphna; Rootenberg, Mark; Perri, Giulia-Anna; Yogaparan, Thirumagal; DeLeon, Maria; Calabrese, Sue; Grief, Cindy J.; Moore, Jennifer; Gill, Ashlinder; Stilos, Kalli; Daines, Patricia; Zimmermann, Camilla; Mazzotta, Paolo

doi:10.1111/jgs.12926

Cited by 23 publications

(23 citation statements)

References 17 publications

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“…34 Another study reported a CFS-weighted kappa of 0.92. 35 Another limitation of CFS in our center is the significant proportion of missing data (28%). As we have shown, missing CFS data are more frequent in situations of very high acuity (including in critical care or surgical areas) or in medical areas when the LOS was short (eg, less than 72 hours).…”

Section: Discussionmentioning

confidence: 96%

The Association of Geriatric Syndromes with Hospital Outcomes

Romero-Ortuño

Forsyth

Wilson

et al. 2017

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 96%

The Association of Geriatric Syndromes with Hospital Outcomes

Romero-Ortuño

Forsyth

Wilson

et al. 2017

Journal of Hospital Medicine

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“…Fifth, frailty assessments could have been performed by 2 raters to increase reliability and prevent misclassification. However, the tool used showed high interrater reliability in a previous study [ 37 ]. Finally, the data should be interpreted with caution due to the small number of participants in the frailest group.…”

Section: Discussionmentioning

confidence: 97%

Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge

Provencher

Sirois

Émond

et al. 2016

Health Qual Life Outcomes

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BackgroundMinor fractures (e.g. wrist, ankle) are risk factors for lower physical health-related quality of life (HRQoL) in seniors. Recent studies found that measures of frailty were associated with decreased physical and mental HRQoL in older people. As most people with minor fractures go to emergency departments (EDs) for treatment, measuring their frailty status in EDs may help stratify their level of HRQoL post-injury and provide them with appropriate health care and services after discharge. This study thus examines the HRQoL of seniors visiting EDs for minor fractures at 3 and 6 months after discharge, according to their frailty status.MethodsThis prospective sub-study was conducted within the larger Canadian Emergency Team Initiative (CETI) cohort. Independent seniors (≥65 years) were recruited in 7 Canadian EDs after treatment for various minor fractures. Frailty status in the ED phase was assessed by the Canadian Study of Health and Aging--Clinical Frailty Scale (CSHA-CFS). The SF-12 questionnaire was completed at 3 and 6 months after ED discharge to ascertain HRQoL. Demographic and clinical data were collected. Linear mixed models were used to test for differences between frailty levels and HRQoL outcomes, controlling for confounding variables and repeated measures over time.ResultsThe sample comprised 334 participants with minor fractures. Prevalence of frailty was as follows: 56.6 % very fit-well; 32.3 % well with treated comorbidities-apparently vulnerable; and 11.1 % mildly-moderately frail. After adjusting for confounding variables, the frailest group showed significantly lower mean HRQoL scores than the fittest group on the physical scale at 3 months (49.3 ± 3.7 vs 60.9 ± 2.0) and 6 months (48.7 ± 3.8 vs 61.1 ± 1.8), as well as on the mental scale at 3 months (59.5 ± 4.4 vs 69.6 ± 1.9). Analyses exploring differences in proportion of patients with HRQoL < 50/100 between the three groups produced similar results.ConclusionsOlder adults with minor fractures who were frail had lower physical and mental HRQoL scores at 3 and 6 months after ED discharge than their fittest counterparts. Measuring the frailty status of older adults who suffered a minor fracture in ED might help clinical decision-making at the time of discharge by providing them with appropriate health care and services to improve their HRQoL in the following months.

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“…As this study was conducted in a real world setting, we were unable to obtain inter-rater reliability. The CFS has previously been demonstrated to have high inter-rater reliability [ 11 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: a prospective cohort study

et al. 2016

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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.

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Enhancing Communication in End‐of‐Life Care: A Clinical Tool Translating Between the Clinical Frailty Scale and the Palliative Performance Scale

Abstract: This conversion chart is a reliable means of translating scores between the CFS and PPS and is useful for geriatric and palliative care teams collaborating in the care of elderly adults.

Cited by 23 publications

References 17 publications

The Association of Geriatric Syndromes with Hospital Outcomes

The Association of Geriatric Syndromes with Hospital Outcomes

Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge

The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: a prospective cohort study

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