Clinical Frailty Scale as a screening indicator of poor prognosis for older patients admitted to geriatric short-stay units from emergency departments.

Abstract

The aging of the population represents a daily challenge for the healthcare system. Post-emergency geriatric short-stay units have been created to meet the specific needs of the older patients, and particularly their frailty. The aim of this study was to assess the prevalence of severely frail patients in geriatric post-emergency units using the Clinical Frailty Scale (CFS) and to evaluate whether frailty serves as a predictive factor for all-cause mortality within a 3-month period. The CFS score at hospital admission and 3-month all-cause mortality were retrospectively evaluated in geriatric inpatients hospitalized in the Post-Emergency short stay Geriatric Unit (PEGU) of Angers hospital. Potential confounders as age, sex, Charlson Comorbidity Index, history of malignancies, excessive polypharmacy, history of hospitalization within the past month, use of anticoagulants, use of psychotropic medications, length of stay in the emergency unit, C-reactive protein (CRP) level at admission, signs of severity on initial admission were assessed and included in a Cox survival model. 701 participants (mean 88.0 years (IQR 83-92); 55.6% women; 29.2% with a CFS > 7) were included. Out of the participants, 111 (15.8%) did not survive for three months after admission. Specifically, 28.3% of the patients with a CFS score ≥ 7 did not survive, compared to 10.7% of the other patients (p < 0.001). CFS score ≥ 7 at admission was directly associated with 3-month all-cause mortality (fully adjusted HR = 2.68 (95% CI: 1.76-4.06) p < 0.001)). Those with CFS score < 7 had longer survival time than the others (log-rank P < 0.001). Severe frailty, defined by a CFS score ≥ 7 during emergency admissions, was associated with increased 3-month mortality among patients admitted to PEGU.