A global clinical measure of fitness and frailty in elderly people
Abstract
Background: There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use.
Methods: We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools.
Results: The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%–30.6%) and entry into an institution (23.9%, 95% CI 8.8%–41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality).
Interpretation: Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
In this issue
Article tools
Jump to section
Related Articles
Cited By...
- Health-related quality of life after 12 months post discharge in patients hospitalised with COVID-19-related severe acute respiratory infection (SARI): a prospective analysis of SF-36 data and correlation with retrospective admission data on age, disease severity, and frailty
- Influence of frailty on cardiovascular events and mortality in patients with Chronic Obstructive Pulmonary Disease (COPD): Study Protocol for a multicentre European observational study
- Clinical phenotypes and outcomes associated with SARS-CoV-2 Omicron variant JN.1 in critically ill COVID-19 patients: a prospective, multicenter cohort study
- Development and external validation of a practical diagnostic support tool, 'ABC2-Screener, to predict sarcopenia among patients on maintenance haemodialysis: A multicentre cross-sectional study
- Using illness trajectories to inform person centred, advance care planning
- Evaluation of a Low-threshold Exercise And Protein supplementation intervention for Women (LEAP-W) experiencing homelessness and addiction: Protocol for a single site intervention study
- Rationale and design of the United Kingdom Heart Failure with Preserved Ejection Fraction Registry
- Tailoring follow-up endoscopy in patients with severe oesophagitis
- Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study
- Unveiling Frailty: Comprehensive and Sex-Specific Characterization in Prematurely Aging PolgA Mice
- What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales
- Longitudinal Fragility Phenotyping Predicts Lifespan and Age-Associated Morbidity in C57BL/6 and Diversity Outbred Mice
- Epidemiology of Tracheostomized Adult Patients Admitted to Specialized Weaning Centers After Acute COVID-19
- Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure
- Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3)
- Prevalence, risks and outcomes of frailty in People Experiencing Homelessness: a protocol for secondary analysis of Health Needs Audit data
- Association between frailty assessed by the Clinical Frailty Scale 2.0 and outcomes of acute stroke in older patients
- Protocol for the Tallaght University Hospital Institute for Memory and Cognition-Biobank for Research in Ageing and Neurodegeneration
- Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen
- Using the Primary care Academic CollaboraTive to explore the characteristics and healthcare use of older housebound patients in England: protocol for a retrospective observational study and clinician survey (the CHiP study)
- GP assessment of unmet need in a complex multimorbid population using a data-driven and clinical triage system: a prospective cohort study
- Comparison of frailty instruments in acute coronary syndrome patients
- Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study
- Protocol of the Berlin Long-term Observation of Vascular Events (BeLOVE): a prospective cohort study with deep phenotyping and long-term follow up of cardiovascular high-risk patients
- Feasibility of frailty screening among patients with advanced heart failure
- Prevalence of frailty among elderly patients with hip fracture in China: protocol for a systematic review and meta-analysis
- Low body mass index patients have worse outcomes after mechanical thrombectomy
- Silver Trauma Review Clinic: a novel model of care to manage non-operative injuries in older patients
- The Healthy Brain Initiative (HBI): A prospective cohort study protocol
- Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery
- Contact patterns of older adults with and without frailty in the Netherlands during the COVID-19 pandemic
- Temporal Muscle Thickness Correlates with Sarcopenia in Parkinsons Disease
- Study protocol for the 'preventing functional decline in acutely hospitalised older patients (PREV_FUNC) study: effects of two multicomponent exercise programmes on physical function - a three-armed randomised controlled trial
- European Respiratory Society statement on frailty in adults with chronic lung disease
- Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis
- Effects of ageing and frailty on circulating monocyte and dendritic cell subsets
- PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study: protocol for a hybrid type I, mixed method, randomised controlled trial
- Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis
- Effect of prehabilitation-related DIETary protein intake on Quality of Recovery after elective cardiac surgery (DIETQoR) study: protocol of a randomised controlled trial
- The impact of frailty on the outcomes of COVID-19 patients with persistent critical illness: A population-based cohort study
- Approche de traitement des adultes ages atteints dinsuffisance renale chronique
- Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach - a Randomised controlled Trial in the Older adult Population considering Surgery
- Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer
- Cross-cultural adaptation and its impact on research in emergency care
- Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study
- Impact of the COVID-19 pandemic on people in need of care or support: protocol for a SARS-CoV-2 registry
- Contact patterns of frail and non-frail elderly persons in the Netherlands during the COVID-19 pandemic
- An approach to treating older adults with chronic kidney disease
- Clinical frailty and polypharmacy in older emergency critical care patients: a single-centre retrospective case series
- Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: a multicentre UK-based study
- Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer
- Development and validation of a hospital frailty risk measure using Canadian clinical administrative data
- Cross-cultural adaptation and its impact on research in emergency care
- Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital
- Association Between Frailty and Antiseizure Medication Tolerability in Older Adults With Epilepsy
- The Silver Trauma Review Clinic: A novel model of care to manage non-operative injuries in older patients
- The Hospital to Home study (H2H): smartwatch technology-enabled rehabilitation following hip fracture in older adults, a feasibility non-randomised trial
- Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
- Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review
- Study protocol for neuromuscular stimulation for rehabilitation after general and vascular surgery: a pilot randomised clinical study
- Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes after Catheter Ablation of Atrial Fibrillation in the Very Elderly (REHEALTH AF) study: rationale and design of a prospective, multicentre, observational, comparative study
- Multimodal prehabilitation for major surgery in elderly patients to lower complications: protocol of a randomised, prospective, multicentre, multidisciplinary trial (PREHABIL Trial)
- Approach to chronic kidney disease in the elderly
- Approche de la nephropathie chronique chez les personnes agees
- Treatment decision-making and care among older adults with kidney failure: protocol for a multicentre, prospective observational cohort study with nested substudies and linked qualitative research (the Elderly Advanced CKD Programme)
- Frailty assessment in the management of cardiovascular disease
- How is COVID-19 changing the ways doctors make end-of-life decisions?
- Short Graphic Values History Tool for decision making during serious illness
- Aetiological and prognostic roles of frailty, multimorbidity and socioeconomic characteristics in the development of SARS-CoV-2 health outcomes: protocol for systematic reviews of population-based studies
- The Forgotten Hip Fracture: Outcomes Of Lower Limb Periprosthetic Fractures
- Investigating the association between IL-6 antagonist therapy and blood coagulation in critically ill patients with COVID-19: a protocol for a prospective, observational, multicentre study
- Association between Goals of Care Designation orders and health care resource use among seriously ill older adults in acute care: a multicentre prospective cohort study
- Emergency care for older people living with frailty: patient and carer perspectives
- Effect of a patient education video and prehabilitation on the quality of preoperative person-centred coordinated care experience: protocol for a randomised controlled trial
- MiCare study, an evaluation of structured, multidisciplinary and personalised post-ICU care on physical and psychological functioning, and quality of life of former ICU patients: a study protocol of a stepped-wedge cluster randomised controlled trial
- Development and validation of a dynamic 48-hour in-hospital mortality risk stratification for COVID-19 in a UK teaching hospital: a retrospective cohort study
- Clinical frailty and performance scale translation in palliative care: scoping review
- Effect of age, sex, and morbidity count on trial attrition: meta-analysis of individual participant level data from phase 3/4 industry funded clinical trials
- PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores
- Development and assessment of an educational intervention to improve the recognition of frailty on an acute care respiratory ward
- Use of a Self-Care and Educational Mobile App to Improve Outcomes of Patients with Acute Decompensated Heart Failure during the COVID-19 Pandemic
- Evaluating instruments for assessing healthspan: a multi-center cross-sectional study on health-related quality of life (HRQL) and frailty in the companion dog
- Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study
- Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study
- Multispecialty multidisciplinary input into comorbidities along with treatment optimisation in heart failure reduces hospitalisation and clinic attendance
- The association of typical and atypical symptoms on in-hospital mortality of older adults with COVID-19: a multicentre cohort study
- Duration of External Neck Stabilisation (DENS) following odontoid fracture in older or frail adults: protocol for a randomised controlled trial of collar versus no collar
- Frailty on the acute medical take
- FARGO-360: a multi-disciplinary survey of practice and perspectives on provision of care for patients with frailty presenting with gynecological cancers in the UK and Ireland
- BLANKETS: a toasty tool to improve social history documentation for our older patients