Abstract
Objectives
Data for the assessment of frailty in acutely ill hospitalized older adults remains
limited. Using the Frailty Index (FI) as “gold standard,” we compared (1) the diagnostic
performance of 3 frailty measures (FRAIL, Clinical Frailty Scale [CFS], and Tilburg
Frailty Indicator [TFI]) in identifying frailty, and (2) their ability to predict
negative outcomes at 12 months after enrollment.
Design
Prospective cohort study.
Participants
We recruited 210 patients (mean age 89.4 ± 4.6 years, 69.5% female), admitted to the
Department of Geriatric Medicine in a 1300-bed tertiary hospital.
Measurements
Premorbid frailty status was determined. Data on comorbidities, severity of illness,
functional status, and cognitive status were gathered. We compared area under receiver
operator characteristic curves (AUC) for each frailty measure against the reference
FI. Multiple logistic regression was used to examine the independent association between
frailty and the outcomes of interest.
Results
Frailty prevalence estimates were 87.1% (FI), 81.0% (CFS), 80.0% (TFI), and 50.0%
(FRAIL). AUC against FI ranged from 0.81 (95% confidence interval [CI] 0.72–0.90:
FRAIL) to 0.91 (95% CI 0.87–0.95: CFS). Only FRAIL was associated with higher in-hospital
mortality (6.7% vs 1.0%, P = .031). FRAIL and CFS were significantly associated with increased length of hospitalization
(10 [6.0–17.5] vs 8 [5.0–14.0] days, P = .043 and 9 [5.0–17.0] vs 7 [4.25–11.75] days, P = .036, respectively). CFS and FI were highly associated with mortality at 12-month
(CFS, frail vs nonfrail: 32.9% vs 2.5%, P < .001, and FI, frail vs nonfrail: 30.6% vs 3.7%, P < .001). CFS also conferred the greatest risk of 12-month mortality (odds ratio [OR]
5.78, 95% CI 3.19–10.48, P < .001) and composite outcomes of institutionalization and/or mortality (OR 3.69,
95% CI 2.31–5.88, P < .001), adjusted for age, sex, and severity of illness.
Conclusion
Our study affirms the utility of frailty assessment tools among older persons in acute
care. FRAIL conferred highest risk of in-hospital mortality. However, CFS had greatest
risk of mortality and institutionalization within 12 months.
Keywords
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Article info
Publication history
Published online: November 15, 2017
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
