Evaluation of clinical frailty screening in geriatric acute care

Chua, Xin Ying; Toh, Sabrina; Wei, Kai; Teo, Nigel; Tang, Terence; Wee, Shiou‐Liang

doi:10.1111/jep.13096

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…Our study included all patients aged 50 years and older. Furthermore, the discrepancy may be owing to a difference in the time frame of readmissions examined in our study (6 months) compared with the study by Chua et al 16 (12 months).…”

Section: Discussioncontrasting

confidence: 73%

“…Our study results also indicated that frailty was associated with readmission for falls after index admission. In contrast, a study by Chua et al 16 indicated that frailty status determined using the CHSA CFS was not associated with a higher rate of rehospitalization within 6 months after hospital discharge. However, this discrepancy might be explained by the differences in inclusion and exclusion criteria between the studies.…”

Section: Discussionmentioning

confidence: 84%

“…However, this discrepancy might be explained by the differences in inclusion and exclusion criteria between the studies. Chua et al 16 excluded patients younger than 70 years, patients with acute functional decline whose frailty status had acutely changed, and patients who were transferred to their facilities from outside institutions. Our study included all patients aged 50 years and older.…”

Section: Discussionmentioning

confidence: 99%

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Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

et al. 2019

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IMPORTANCE Falls have been associated with morbidity and mortality in elderly patients. Assessment of frailty at hospital admission may help health care professionals evaluate fall risk in patients with trauma-related injury. OBJECTIVE To determine whether frailty assessed using the Canadian Study of Health and Aging Clinical Frailty Scale is associated with readmission for falls after index admission for trauma-related injury in patients aged 50 years and older. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study reviewed the medical records of 804 patients aged 50 years and older with trauma-related injury who were admitted to the University of Iowa Hospitals and Clinics between July 1, 2010, and June 30, 2015. Records were reviewed from May 30 to August 1, 2017, and patient demographics, admission data, injury severity scores, history of falls, and postindex readmission data for ground-level falls were recorded. Frailty scores were calculated using the Canadian Study of Health and Aging Clinical Frailty Scale. Patients with a score of 5 or higher were classified as frail. MAIN OUTCOMES AND MEASURES Frailty assessed using the Canadian Study of Health and Aging Clinical Frailty Scale and readmission for falls after index admission for trauma-related injury. RESULTS A total of 804 patients with trauma-related injury were included in the study. The mean (SD) age was 70 (13.4) years; 744 patients (93.4%) were white, and 380 (47.3%) were men. Among the total population, the mortality rate was 3.7%; 255 patients (31.7%) were classified as frail and 549 (68.3%) as nonfrail. The mean (SD) injury severity score was 9.8 (7.9), and the score was similar between frail and nonfrail patients. Of 255 frail patients, 179 (70.2%) were women, and frail patients were significantly older than nonfrail patients (mean [SD], 79.2 [12.1] years vs 66.2 [11.9] years, respectively; P < .001). The percentages of frail patients presenting to the hospital with a history of falls and readmitted for falls after index admission were higher than those of nonfrail patients (63 [24.8%] vs 53 [9.6%] and 55 [21.6%] vs 58 [10.6%], respectively; both P < .001). Frailty was associated with discharge to the home with health care (odds ratio [OR], 4.82; 95% CI, 2.10-11.01;

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

et al. 2019

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…One instrument that has been validated in the inpatient setting is the Clinical Frailty Scale (CFS) (Figure 1), which is a simple face to face clinician assessment of frailty status [9]. The CFS can be rapidly scored within a clinical environment and has demonstrated high inter-rater reliability in a range of hospital settings, including the emergency department, intensive care and geriatric acute care [9][10][11][12]. The CFS has been found to predict clinical outcomes including mortality and dependence on health care in a range of settings [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study

Marincowitz¹,

Turner²,

Allgar³

et al. 2019

Adv Geriatr Med Res

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Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen's Kappa was used to estimate inter-rater reliability (IRR) between the assessments. Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.

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Evaluation of clinical frailty screening in geriatric acute care

Cited by 21 publications

References 32 publications

Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury

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

Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study

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