Translating Performance Level to Clinical Frailty Scale Category Simplifies Scoring and Indicates Length of Stay and Outcome: A Longitudinal Observational Study

Abstract

Objectives: To group performance level scores of hospice inpatients using the clinical frailty scale to explore the association between performance, frailty, outcomes and Length of Stay (LOS). Methods: Australia-modified-Karnofsky-Status was recorded for admissions to three hospices in England (April 2017 to April 2018) and cross-mapped to the Clinical-Frailty-Scale. We explored relationships between performance, frailty, demographics, diagnosis, LOS, and outcome (death/discharge) using Kaplan- Meier survival curves and logistic regression. Results: 419 admissions were recorded from 406 people (51.8% female, mean age=69.0, sd=13.1).158 (37%) were severely/very severely frail (AKPS 10-30) on admission. Of these, 140(88.7%) died after a short stay (median 11.5 and 5.0 days respectively). 112(26.7%) had no/mild frailty (AKPS 60-100) at admission. Of these, 82(73%) were discharged after(median) 23 and 28 days respectively. 149 people had moderate frailty(AKPS 40-50), 126(84.6%)of these were admitted for symptom control, but most(n=93, 62.4%) died after(median)19 days. In this group, frailty was stable in people who were discharged, and declined rapidly over the 14 days before death in decedents. Similar patterns were observed across cancer and non-cancer patients. Conclusions: Measuring frailty, or dividing performance scores using frailty categories, could support decision making in hospices. Frailty seems to divide cancer and non-cancer hospice-inpatients into three groups: Those with severe frailty, at high risk of dying with short LOS. Patients with mild/no frailty, moderate LOS and high discharge rates. Those with moderate frailty, long LOS and similar rates of discharge/death. However, the latter two groups are targets for future research as associations between frailty and length of stay were less clear.