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Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes.
J Am Med Dir Assoc. 2018 05; 19(5):450-457.e3.JA

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.

Authors+Show Affiliations

Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. Electronic address: edward_chong@ttsh.com.sg.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.Department of General Medicine, Sengkang General Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29153536

Citation

Chong, Edward, et al. "Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes." Journal of the American Medical Directors Association, vol. 19, no. 5, 2018, pp. 450-457.e3.
Chong E, Ho E, Baldevarona-Llego J, et al. Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes. J Am Med Dir Assoc. 2018;19(5):450-457.e3.
Chong, E., Ho, E., Baldevarona-Llego, J., Chan, M., Wu, L., Tay, L., Ding, Y. Y., & Lim, W. S. (2018). Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes. Journal of the American Medical Directors Association, 19(5), 450-e3. https://doi.org/10.1016/j.jamda.2017.10.006
Chong E, et al. Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes. J Am Med Dir Assoc. 2018;19(5):450-457.e3. PubMed PMID: 29153536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes. AU - Chong,Edward, AU - Ho,Esther, AU - Baldevarona-Llego,Jewel, AU - Chan,Mark, AU - Wu,Lynn, AU - Tay,Laura, AU - Ding,Yew Yoong, AU - Lim,Wee Shiong, Y1 - 2017/11/15/ PY - 2017/10/03/received PY - 2017/10/05/accepted PY - 2017/11/21/pubmed PY - 2019/11/19/medline PY - 2017/11/21/entrez KW - Frailty KW - acute KW - geriatric KW - inpatient KW - risk SP - 450 EP - 457.e3 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 19 IS - 5 N2 - 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. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/29153536/Frailty_in_Hospitalized_Older_Adults:_Comparing_Different_Frailty_Measures_in_Predicting_Short__and_Long_term_Patient_Outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(17)30580-7 DB - PRIME DP - Unbound Medicine ER -