Prediction of one-year mortality by five different frailty instruments: A comparative study in hospitalized geriatric patients

Ritt, Martin; Bollheimer, Leo Cornelius; Sieber, Cornel; Gaßmann, K-G

doi:10.1016/j.archger.2016.05.004

Cited by 41 publications

(48 citation statements)

References 35 publications

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“…This score provides nine possible levels of frailty, ranging from fully independent (lowest score) to bed bound and includes both a brief written description and a pictorial description 16. It is strongly predictive of 12-month mortality in patients hospitalised on geriatric wards17 and critical illness settings18 and can be applied by junior medical staff without training 19…”

Section: Methodsmentioning

confidence: 99%

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Mudge

Douglas

Sansome

et al. 2018

BMJ Support Palliat Care

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Section: Methodsmentioning

confidence: 99%

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Mudge

Douglas

Sansome

et al. 2018

BMJ Support Palliat Care

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“…However, we enrolled a diverse cohort and we were more interested in less severely frail patients who are amenable to preventive strategies. Although we did not compare different tools or assess more objective frailty measures, we selected a frailty tool that is easy to use, reliable and predictive of clinically relevant outcomes, [16][17][18] and that has been recommended for use in other surgical populations. 13 We did not assess long-term disability or quality of life, which may be of particular importance to clinicians and patients.…”

Section: Limitationsmentioning

confidence: 99%

“…6 The Canadian Study of Health and Aging Clinical Frailty Scale 15 is a previously validated 9-point global subjective assessment of comorbidity and function that does not require specialized training or entail extensive assessment; 16 it has surpassed more complex frailty assessments in predicting readmission and mortality. 17,18 Very few studies have examined the risk associated with frailty for subsequent health care utilization in any surgical group. 18 Therefore, we assessed the impact of preadmission frailty on 30-day and 6-month readmission or death in older patients undergoing emergency abdominal surgery.…”

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confidence: 99%

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Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Pederson

Churchill

et al. 2018

CMAJ

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Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. METHODS:We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as "well" (score 1 or 2), "vulnerable" (score 3 or 4) or "frail" (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression. (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01-4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32-8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well. INTERPRETATION:Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission. Trial registration for primary study: ClinicalTrials. gov, no. NCT02233153

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“…The CFS is a 9-point global frailty scale based on clinical evaluation in the domains of mobility, energy, physical activity and function [2]. Despite its relative simplicity and ease of use, the CFS is equally discriminative in predicting mortality compared to frailty indices containing 40+ variables [4, 27]. Additionally, the CFS may be more feasible for clinical use than other frailty instruments based on a smaller number of missing responses [4].…”

Section: Methodsmentioning

confidence: 99%

Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: study protocol for a prospective cohort study

et al. 2016

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BackgroundFrailty is an aggregate expression of susceptibility to poor outcomes, owing to age-, and disease-related deficits that accumulate within multiple domains. Older patients who are frail before surgery are at an increased risk of morbidity and mortality, and use a disproportionately high amount of healthcare resources. While frailty is now a well-established risk factor for adverse postoperative outcomes, the perioperative literature lacks studies that: 1) compare the predictive accuracy of different frailty instruments; 2) consider the impact of frailty on patient-reported outcome measures; and 3) consider the acceptability and feasibility of using frailty instruments in clinical practice.MethodsWe will conduct a multicenter prospective cohort study comparing the predictive accuracy of the modified Fried Index (mFI) with the Clinical Frailty Scale (CFS) among consenting patients aged 65 years and older having elective major non-cardiac surgery. The primary outcome will be disability free survival at 90 days after surgery, a patient-reported outcome measure. Secondary outcomes will include complications, length of stay, discharge disposition, readmission and total health system costs. We will compare the accuracy of frailty instruments using the relative true positive rate and relative false positive rate. These measures can be interpreted as the relative difference in the probability of one instrument identifying a true case of death or new disability compared to another instrument, or the relative difference in the probability of one instrument identifying a false case of death or new disability, respectively. We will also assess the acceptability and feasibility of each instrument.DiscussionFrailty is an important prognostic factor in the growing population of older patients having surgery. This study will provide novel findings regarding the choice of an accurate, clinically useable frailty instrument in predicting patient reported outcomes, as well as morbidity, mortality and resource use. These findings will inform current practice and future research.

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Prediction of one-year mortality by five different frailty instruments: A comparative study in hospitalized geriatric patients

Cited by 41 publications

References 35 publications

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: study protocol for a prospective cohort study

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