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

Abstract

Background: Increasing 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.

Methods: This 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.

Results: Frailty 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).

Conclusions: A 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.

Keywords: Activities of daily living; Aged; Frail elderly; Frailty; Hospitalization; Survival.

Fig. 1

For each increased level of frailty there is a corresponding increase in the percentage of people experiencing functional decline (frailty score 1-3: 34 %, 4-5: 46 % and 6-8: 70 %). There was an overall trend for increasing mortality with increasing frailty (frailty score 1-3: 10 %, 4-5:4 %, 6-8: 10 % and 9: 100 %)