K.J. Gregorevic, R.E. Hubbard, W.K. Lim, B. Katz
BMC Geriatr. 2016;16(1):117
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.
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.
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).
Comment: This study demonstrates the feasibility of using the Clinical Frailty Scale in the acute general medical setting. The CFS correlates with the important outcomes of death and functional decline. This is the first study the authors are aware of, where no training was provided to junior doctors in order to examine how the CFS functions in a real world setting. This study also shows that this scale is highly acceptable to medical staff as there was a 95 % completion rate. It was completed with information obtained on routine assessment at the time of admission, so the additional workload for junior medical staff was minimal. The combination of acceptability and prognostic guidance supports the role of the CFS as a tool to identify patients most suitable for comprehensive geriatric assessment.