Evaluation of clinical frailty screening in geriatric acute care

While frailty status is an attractive risk stratification tool, the evaluation of

frailty in acute care can be challenging as some inpatients are unable to complete

performance‐based tests as part of frailty assessment and some toolsmay lack discriminative

ability and categorize majority of cohorts as “frail”. In this study, we evaluated the feasibility

of frailty screening with the simple clinical frailty scale (CFS) by different clinicians,

and its association with mortality and rehospitalization in a geriatric acute care setting.

Methods: This study took place in GeriatricMedicine Department of a General Hospital

in Singapore.We analysed records of 314 inpatients aged 70 years and older. At baseline,

premorbid frailty was assessed using the CFS of the Canadian Study on Health and

Aging. Demographic characteristics and other variableswere retrieved from theirmedical

records. Primary outcomes were mortality and rehospitalization during the 6‐month

follow‐up. Survival analysis was used to compare the time to death and rehospitalization

among CFS categories (1‐4: nonfrail, 5‐6: mild‐moderate frail, and 7‐8: severe frail).

Results: CFS showed a high inter‐rater reliability when used by different clinicians.

In the Cox proportional hazard model controlling for age, gender, Charlson comorbidity

index, modified severity of illness index, and discharge placements, severe frailty

determined by CFS (HR = 2.09, 95% CI = 1.01‐4.33, P = 0.047) and CFS scores

(HR = 1.27, 95% CI = 1.05‐1.53, P = 0.012) were significantly associated with higher

mortality until 6‐month postdischarge, but not rehospitalization.

Conclusion: Frailty status determined by CFS adds to disease severity and comorbidity

in predicting short‐term mortality but not rehospitalization in older inpatients

who received geriatric acute care in our setting. CFS is reliable and has the potential

to be incorporated into routine screening to better identify, communicate, and

address frailty in the acute settings.