Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;12(2):275-284.
doi: 10.1007/s41999-020-00418-8. Epub 2020 Oct 23.

Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale

Edward Chong  1   2 , Mark Chan  3   4 , Huei Nuo Tan  3   4 , Wee Shiong Lim  3   4
Affiliations

Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale

Edward Chong et al. Eur Geriatr Med. 2021 Apr.

Abstract

Purpose: Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined the utility of subgrouping the CFS in predicting mortality and institutionalisation.

Methods: We prospectively studied 201 hospitalised frail patients (89.5 ± 4.7 years, female 70.1%). We examined Katz Index (KI) against adverse outcomes in CFS6 (n = 106). We then compared predictive performances of a modified CFS version 1 (mCFS-1; category 6A: CFS6 and KI ≥ 2; 6B: CFS6 and KI ≤ 1) and modified CFS version 2 (mCFS-2; category 6A: CFS6 and KI ≥ 2; 6B1: CFS6, KI ≤ 1 and feeding independent; 6B2: CFS6, KI ≤ 1 and feeding dependent) against the CFS. Multivariate analysis was used to compare each tool against mortality and institutionalisation. Receiver operator characteristic analysis was performed to determine area under curve and optimal cut-points for each tool.

Results: KI ≤ 1 in CFS6 was associated with higher 12-month mortality (39.3% vs. 15.6%, p = 0.01); amongst KI items, feeding dependent predicted 12-month mortality (p < 0.05). Using mCFS-1, category 6A did not increase 12-month mortality compared with category 5 (OR 1.83, 95% CI 0.52-6.47), unlike category 6B (OR 6.33, 95% CI 2.07-19.33). mCFS-2 produced higher mortality in category 6B1 (OR 5.19, 95% CI 1.30-20.69) and 6B2 (OR 6.92, 95% CI 2.14-22.35). Similar observations were seen for institutionalisation. Optimal cut-point for 12-month mortality was category 6 for CFS, and 6B and 6B1 for mCFS-1 and mCFS-2, respectively.

Conclusion: This study corroborates the heterogeneity of functional status in moderately frail individuals and validates the use of a modified approach to subgrouping the CFS6 via bADL functional status for improved predictive performance.

Keywords: Acute; Frailty; Geriatrics; Inpatient; Outcomes; Risks.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

References

    1. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397. doi: 10.1016/j.jamda.2013.03.022. - DOI - PMC - PubMed
    1. Woo J. Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Eur Geriatr Med. 2018;9:273–276. doi: 10.1007/s41999-018-0056-0. - DOI - PubMed
    1. Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Health Aging. 2019;23(9):771–787. doi: 10.1007/s12603-019-1273-z. - DOI - PMC - PubMed
    1. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–495. doi: 10.1503/cmaj.050051. - DOI - PMC - PubMed
    1. Chong E, Ho E, Baldevarona-Llego J, Chan M, Wu L, Tay L. Frailty and risk of adverse outcomes in hospitalized older adults: a comparison of different frailty measures. J Am Med Dir Assoc. 2017;18(7):638.e7–638.e11. doi: 10.1016/j.jamda.2017.04.011. - DOI - PubMed