Frailty Risk Effectively Predicted With Simple, Inexpensive Method

The Hospital Frailty Risk Score is an effective method for screening adults with a higher risk of frailty and related adverse outcomes, according to a new study.

The score was developed and tested using a 3-step approach. Hospitalized older adults aged 75 years or older who had high resource use and diagnoses associated with frailty were identified via cluster analysis, and the effectiveness of the risk score was subsequently tested in a development cohort (n = 22,139) and a national validation cohort (n = 1,013,590).
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The researchers found that participants in the development cohort with frailty diagnoses had higher non-elective hospital use (33.6 bed-days over 2 years compared with 23.0 bed-days for the group with the next highest number of bed-days).

Results indicated that the 202,718 (20.0%) participants in the national validation cohort with the highest Hospital Frailty Risk Scores had a higher risk of 30-day mortality (odds ratio [OR] 1.71), long hospital stay (OR 6.03), and 30-day readmission (OR 1.48) compared with the 429,762 (42.4%) participants with the lowest risk scores.

The c statistics for 30-day mortality, long hospital stay, and 30-day readmission were 0.60, 0.68, and 0.56, respectively.

Ultimately, the Hospital Frailty Risk Score demonstrated fair overlap with dichotomized Fried and Rockwood scales (kappa scores 0.22) and moderate agreement with the Rockwood Frailty Index (Pearson's correlation coefficient 0.41).

“The Hospital Frailty Risk Score provides hospitals and health systems with a low-cost, systematic way to screen for frailty and identify a group of patients who are at greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful,” the researchers concluded.

—Christina Vogt

Reference:

Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study [Published online April 26, 2018]. Lancet. https://doi.org/10.1016/S0140-6736(18)30668-8