At-Point Clinical Frailty Scale as a Universal Risk Tool for Older Inpatients in Acute Hospital: A Cohort Study

Hee-Won Jung; Ji Yeon Baek; Young Hye Kwon; Il-Young Jang; Dae Yul Kim; Hyouk-Soo Kwon; Sun Hee Lee; Hyun Jin Oh; Eunju Lee; Younsuck Koh

doi:10.3389/fmed.2022.929555

At-Point Clinical Frailty Scale as a Universal Risk Tool for Older Inpatients in Acute Hospital: A Cohort Study

Front Med (Lausanne). 2022 Jul 6:9:929555. doi: 10.3389/fmed.2022.929555. eCollection 2022.

Authors

Affiliations

¹ Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
² Department of Nursing, Asan Medical Center, Seoul, South Korea.
³ Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Department of Internal Medicine, Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁵ Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea.

Abstract

Background: While the Clinical Frailty Scale (CFS) has been extensively validated for predicting health outcomes in older adults, the role of the at-point CFS at the time of examination is unclear. We aimed to examine the ability of the at-point CFS for predicting clinical outcomes of older inpatients.

Methods: As a single-center and prospective cohort study, we enrolled 1,016 older adults who were 65 years or older and were admitted to one of 9 medical or surgical units from May 2021 to September 2021. The associations of the at-point CFS with outcomes of falls, delirium, pressure ulcers, 30-day unplanned readmission and/or emergency department (ED) visits, institutionalization, and a composite outcome were analyzed.

Results: In the study population (n = 1,016), 26 patients had incident pressure ulcers, 6 patients had falls, 50 patients experienced delirium, and 13 patients died during hospitalization. Also, 37 patients experienced an ED visit and 22 patients had an unplanned readmission within 30 days after discharge. The composite outcome was 1.7% among patients with the CFS < 5 and 28.5% among patients with the CFS ≥ 5. The higher CFS was associated with an increased risk of a fall [odds ratio (OR) 1.74 (1.01-3.01)], pressure ulcers [OR 3.02 (2.15-4.23)], delirium [OR 2.72 (2.13-3.46)], 30-day readmission [OR 1.94 (1.44-2.62)], ED visit [OR 1.81 (1.47-2.23)], death [OR 3.27 (2.02-5.29)], and institutionalization after discharge [OR 1.88 (1.62-2.18)].

Conclusion: The at-point CFS assessed in older inpatients can screen high-risk individuals who might experience adverse geriatric conditions and in-hospital outcomes.

Keywords: Clinical Frailty Scale; adverse health outcomes; in-hospital outcomes; older adults; screening tool.