Clinical frailty scale score during geriatric rehabilitation predicts short-term mortality: RESORT cohort study - 10/02/22

Doi : 10.1016/j.rehab.2022.101645

Cheng Hwee Soh ^a, Wen Kwang Lim ^a, Esmee M. Reijnierse ^a,^b, Andrea B. Maier ^a,^b,^c,^d,^⁎
^a Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
^b Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
^c Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
^d Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore

^⁎Correspondence to: Andrea B. Maier, @Age, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorstsraat 7, 1081 BT Amsterdam, The Netherlands.@Age, Department of Human Movement Sciences, Faculty of Behavioural and Movement SciencesVrije Universiteit Amsterdam, Amsterdam Movement SciencesVan der Boechorstsraat 7, 1081 BTAmsterdamThe Netherlands

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Highlights

•	Clinical Frailty Scale score (CFS) at admission was significantly associated with in-hospital mortality.
•	CFS score at admission and discharge were associated with post-discharge mortality.
•	Patients with an increased CFS score had a higher risk of 3-month mortality.
•	The CFS is a prognostic tool for mortality in geriatric rehabilitation inpatients.

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Abstract

Background

Frailty is associated with poor health outcomes, such as functional decline and institutionalization. The Clinical Frailty Scale (CFS) is a judgement-based frailty assessment tool developed to identify frail adults and assess level of frailty.

Objectives

We aimed to determine the association between CFS at admission and discharge, admission-discharge change, and mortality in individuals admitted to geriatric rehabilitation.

Methods

REStORing health of acutely unwell adulTs (RESORT) is a longitudinal, observational inception cohort of consecutive individuals admitted to geriatric rehabilitation at the Royal Melbourne Hospital, Melbourne, Australia. The CFS was assessed at admission and discharge from geriatric rehabilitation. Logistic regression was used to examine the association between CFS score at admission and in-hospital mortality. Cox proportional hazards regression analysis was used to analyse associations between CFS at admission and discharge, admission-to-discharge change, and 3-month and 1-year mortality.

Results

A total of 1766 participants were included: median age was 83.4 years (Interquartile range [IQR] 77.6-88.4), 57% were female, median length of stay in geriatric rehabilitation was 20 days (13.8-31.7) and median CFS score was 6 (5-7) at both admission and discharge. Increased CFS score was associated with in-hospital mortality (odds ratio [OR] 1.8, 95% CI 1.4-2.4), 3-month mortality and 1-year mortality (admission CFS: hazard ratio [HR] 1.4, 95% CI 1.2-1.6; discharge CFS: HR 1.4, 95% CI 1.2-1.7). Risk of 3-month mortality was increased when CFS score increased from admission to discharge (HR 2.1, 95% CI 1.2-3.8) as compared with when it decreased.

Conclusion

CFS score at admission and discharge was associated with post-discharge mortality in individuals admitted to geriatric rehabilitation. These findings support the use of the CFS in clinical settings to assist clinical characterisation and decision making.

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Keywords : Frailty, geriatric assessment, rehabilitation, mortality, aged