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Comparative Study
. 2016 Aug;11(8):556-62.
doi: 10.1002/jhm.2607. Epub 2016 May 17.

Comparing Three Different Measures of Frailty in Medical Inpatients: Multicenter Prospective Cohort Study Examining 30-day Risk of Readmission or Death

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Comparative Study

Comparing Three Different Measures of Frailty in Medical Inpatients: Multicenter Prospective Cohort Study Examining 30-day Risk of Readmission or Death

Sara Belga et al. J Hosp Med. .

Abstract

Background: Multiple tools are used to identify frailty.

Objective: To compare the global Clinical Frailty Scale (CFS) with more objective phenotypic tools (modified Fried score and the Timed Up and Go Test [TUGT]).

Design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Participants: Adults being discharged back to the community.

Measurements: All frailty assessments were done within 24 hours of discharge. Patients were classified as frail if they scored ≥5 on the CFS and/or ≥3 on the modified Fried score, and/or had reduced mobility (>20 seconds on the TUGT). The main outcome was readmission or death within 30 days.

Results: Of 495 patients, 211 (43%) were frail according to at least 1 assessment, 46 (9%) met all 3 frailty definitions, and 17% died or were readmitted to the hospital within 30 days. Although patients classified as frail on the CFS exhibited significantly higher 30-day readmission/death rates (23% vs 14% for not frail, P = 0.005; 28% vs. 12% in the elderly, P < 0.001), even after adjusting for age and sex (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.19-3.41 for all adults; aOR: 3.20, 95% CI: 1.55-6.60 for the elderly), patients meeting either of the phenotypic definitions for frailty but not the CFS definition were not at higher risk of 30-day readmission/death (aOR: 0.87, 95% CI: 0.34-2.19 for all adults and aOR: 1.41, 95% CI: 0.72-2.78 for the elderly).

Conclusions: Frailty has a significant impact on postdischarge outcomes, and the CFS is the most useful of the frequently used frailty tools for predicting poor outcomes after discharge. Journal of Hospital Medicine 2016;11:556-562. © 2016 Society of Hospital Medicine.

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