Does the Clinical Frailty Score predict functional decline?
Research type
Research Study
Full title
Does the Clinical Frailty Score predict functional decline and mortality when used by junior doctors: a prospective observational cohort study
IRAS ID
225713
Contact name
Rebekah Young
Contact email
Sponsor organisation
Research and Development
Duration of Study in the UK
0 years, 3 months, 1 days
Research summary
As people get older, they frequently lose muscle and strength and slow down. This combination is called frailty. Increasing frailty is associated with a reduction in the ability to care for one’s self, and people who are very frail are more likely to die in hospital or in the months after discharge. There are many ways of assessing how frail people are; at the Princess Royal University Hospital we use the Clinical Frailty Scale (CFS). The CFS has 9-levels where the medical team makes an assessment as to how frail a person is based upon a clinical assessment of memory, walking, function and medical problems. This method is based upon routine history and physical examination which makes it simple to use. In previous studies, the CFS has been found to predict important outcomes, such as survival and admission into a care home. The ability to measure frailty is important both clinically and at a health care policy level, allowing doctors to predict adverse outcomes, identify appropriate services and plan treatments.
The aim of the study is to determine whether the CFS can be routinely used by junior doctors in the acute medical setting, whether this is reproducible or varies between staff, and whether this independently predicts functional decline, readmission to hospital, admission to a care home and death. Previous tools used to measure frailty require expert geriatrician input, extra resources and time, but this study will investigate whether junior doctors with no previous training are able to use this tool successfully.
From those admitted to the Acute Frailty wards (PRUH), 120 people will be recruited during their hospital admission, and contacted by telephone 3 months following discharge. During the telephone call, information such as number of further admissions, where the person is living and whether they have died will be asked.
Lay summary of study results: A total of 45 participants were recruited on the frailty ward at Newham Hospital in 2018, and were followed up on discharge via a telephone call, with a mean follow up time of 352 days. Data was analysed using Pearson’s Correlation Co-efficient, to see if there was correlation between the Clinical Frailty Scale and other variables.
There was a small positive correlation between the Clinical Frailty Score and increasing participant age, increasing length of hospital admission, reduced walking ability in the form of an increased time to complete the “Up and go” test, and mortality rate post-discharge. Unfortunately due to small numbers, these were not clinically significant with regards to P values > 0.05. There was little difference in participant functional decline following 1 year after discharge, with regards to increasing numbers of co-morbidities and medications, reduced walking ability, reduced cognition, or institutionalisation.
The routine identification of frailty is good practice, given its ability to predict outcome in multiple clinical scenarios. An increasing CFS score suggests likely increased lengths of hospital admissions, reduced walking ability and increased mortality rates post-discharge, and therefore identification of these patients allows us to start a care pathway to address the issues contributing to frailty, and avoid adverse outcomes.
Although the results are promising, the results are hindered by the small number of patients recruited. The initial protocol was to recruit 100 patients, however due to logistical reasons it was only possible to recruit 45.
Assessing an older person’s severity of frailty on admission is accepted as good practice and can predict outcome in many clinical situations. The purpose of assessing frailty prior to discharge is less certain and further work is required to demonstrate benefit before it is adopted into clinical practice.
REC name
London - Queen Square Research Ethics Committee
REC reference
17/LO/1857
Date of REC Opinion
31 Jan 2018
REC opinion
Further Information Favourable Opinion