Comparing three different measures of frailty in medical inpatients: Multicenter prospective cohort study examining 30-day risk of readmission or death

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