The assessment of frailty in older people in acute care

Authors

  • Sarah N Hilmer,

    Corresponding author
    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards; and Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
      Dr Sarah N Hilmer, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital. Email: shilmer@med.usyd.edu.au
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  • Vidya Perera,

    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards; and Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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  • Sarah Mitchell,

    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards; and Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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  • Bridin P Murnion,

    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards; and Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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  • Jonathan Dent,

    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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  • Beata Bajorek,

    1. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards; and Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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  • Slade Matthews,

    1. Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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  • Darryl B Rolfson

    1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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  • The authors have no financial or personal conflicts of interest.

  • There was no specific funding for this project, which was carried out by staff and students of the Royal North Shore Hospital and University of Sydney.

Dr Sarah N Hilmer, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital. Email: shilmer@med.usyd.edu.au

Abstract

Aim:  Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians.

Method:  The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability.

Results:  REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31).

Conclusion:  In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy.

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