The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature.
acute clinical settings
clinical frailty scale
literature review
risk stratification
Journal
Clinical interventions in aging
ISSN: 1178-1998
Titre abrégé: Clin Interv Aging
Pays: New Zealand
ID NLM: 101273480
Informations de publication
Date de publication:
2023
2023
Historique:
received:
13
09
2022
accepted:
14
12
2022
entrez:
27
2
2023
pubmed:
28
2
2023
medline:
3
3
2023
Statut:
epublish
Résumé
Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Systematic review with narrative synthesis. Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
Sections du résumé
Background
UNASSIGNED
Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.
Purpose
UNASSIGNED
To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings.
Design
UNASSIGNED
Systematic review with narrative synthesis.
Methods
UNASSIGNED
Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020.
Results
UNASSIGNED
Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.
Conclusion
UNASSIGNED
A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
Identifiants
pubmed: 36843633
doi: 10.2147/CIA.S388160
pii: 388160
pmc: PMC9946013
doi:
Types de publication
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
249-261Informations de copyright
© 2023 Falk Erhag et al.
Déclaration de conflit d'intérêts
Dr Joakim Alfredsson reports personal fees from Boehringer Ingelheim, MSD, and Astra Zeneca, outside the submitted work. Dr Tommy Cederholm reports personal fees from Nutricia, Nestle, Fresenius-Kabi, Abbott, and Pfizer, outside the submitted work. The authors report no other conflicts of interest in this work.
Références
Anesthesiology. 2020 Jul;133(1):78-95
pubmed: 32243326
Age Ageing. 2015 Jul;44(4):545-7
pubmed: 25824236
Intensive Care Med. 2020 Jan;46(1):57-69
pubmed: 31784798
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Clin Res Cardiol. 2017 Jul;106(7):533-541
pubmed: 28204965
Age Ageing. 2014 Jan;43(1):10-2
pubmed: 24132852
Front Med (Lausanne). 2022 Mar 31;9:811524
pubmed: 35433739
J Hosp Med. 2016 Aug;11(8):556-62
pubmed: 27187268
J Am Med Dir Assoc. 2018 May;19(5):450-457.e3
pubmed: 29153536
BMJ Support Palliat Care. 2020 Jun;10(2):164-174
pubmed: 32241957
Can J Anaesth. 2020 Jun;67(6):694-705
pubmed: 32128722
Lancet. 2013 Mar 2;381(9868):752-62
pubmed: 23395245
CMAJ. 2014 Feb 4;186(2):E95-102
pubmed: 24277703
BMC Geriatr. 2020 Mar 13;20(1):102
pubmed: 32164580
Ann Intern Med. 2020 Jan 7;172(1):12-21
pubmed: 31816630
J Am Geriatr Soc. 2006 Jun;54(6):991-1001
pubmed: 16776798
J Surg Res. 2018 Oct;230:13-19
pubmed: 30100028
CMAJ. 2020 Jan 6;192(1):E3-E8
pubmed: 31907228
J Trauma Acute Care Surg. 2022 Mar 1;92(3):615-626
pubmed: 34789703
Crit Care Med. 2019 Aug;47(8):e669-e676
pubmed: 31135504
Eur J Intern Med. 2016 Jun;31:3-10
pubmed: 27039014
Age Ageing. 2020 Jul 1;49(4):588-591
pubmed: 31951248
Clin Interv Aging. 2017 Feb 08;12:293-304
pubmed: 28223787
J Am Coll Surg. 2017 Nov;225(5):658-665.e3
pubmed: 28888692
Eur J Prev Cardiol. 2018 Nov;25(17):1813-1821
pubmed: 30247067
Crit Care. 2018 Feb 26;22(1):49
pubmed: 29478414
Intensive Care Med. 2017 Dec;43(12):1820-1828
pubmed: 28936626
Eur Heart J Acute Cardiovasc Care. 2022 Feb 8;11(2):89-98
pubmed: 34905049
Syst Rev. 2021 Mar 29;10(1):89
pubmed: 33781348
Med J Aust. 2019 Oct;211(7):318-323
pubmed: 31489652
BMC Geriatr. 2016 Feb 29;16:55
pubmed: 26927924
Circulation. 2011 Nov 29;124(22):2397-404
pubmed: 22064593
Can Geriatr J. 2020 Sep 01;23(3):210-215
pubmed: 32904824
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):738-43
pubmed: 17634321
CMAJ. 2018 Feb 20;190(7):E184-E190
pubmed: 29565018
J Am Med Dir Assoc. 2017 Jul 1;18(7):638.e7-638.e11
pubmed: 28587850
J Orthop Trauma. 2019 Oct;33(10):497-502
pubmed: 31188261
Arch Gerontol Geriatr. 2016 Sep-Oct;66:66-72
pubmed: 27259029
BMC Geriatr. 2020 Oct 7;20(1):393
pubmed: 33028215
Ageing Res Rev. 2011 Jan;10(1):104-14
pubmed: 20850567
Eur J Prev Cardiol. 2014 Oct;21(10):1216-24
pubmed: 23644488
J Crit Care. 2020 Feb;55:79-85
pubmed: 31715535
J Gerontol A Biol Sci Med Sci. 2017 Jan;72(1):68-74
pubmed: 26400735
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Anaesthesiol Intensive Ther. 2018;50(4):245-251
pubmed: 30242826
Aging Clin Exp Res. 2020 Nov;32(11):2225-2232
pubmed: 31898172
Ann Intern Med. 2013 Feb 19;158(4):280-6
pubmed: 23420236
J Hosp Med. 2017 Feb;12(2):83-89
pubmed: 28182802
Can J Diabetes. 2020 Apr;44(3):241-245.e1
pubmed: 31466827
Diagn Progn Res. 2019 Mar 07;3:5
pubmed: 31093575
Geriatr Gerontol Int. 2018 Apr;18(4):530-537
pubmed: 29230961
J Am Geriatr Soc. 2013 Sep;61(9):1537-51
pubmed: 24028357
Arch Gerontol Geriatr. 2019 Jan - Feb;80:104-114
pubmed: 30448693
J Aging Health. 2015 Jun;27(4):670-85
pubmed: 25414168
QJM. 2015 Dec;108(12):943-9
pubmed: 25778109
J Eval Clin Pract. 2020 Feb;26(1):35-41
pubmed: 30632249
Eur J Prev Cardiol. 2022 Feb 19;29(1):216-227
pubmed: 34270717
Eur J Intern Med. 2019 Jun;64:41-47
pubmed: 30819605