Modified Hospital Frailty Risk Score (mHFRS) as a Tool to Identify and Predict Outcomes for Hospitalised Older Adults at Risk of Frailty

Abstract

OBJECTIVES This study aims to determine whether modified Hospital Frailty Risk Score (mHFRS) can identify frail hospitalised older adults by comparing mHFRS to HFRS and Clinical Frailty Scale (CFS). METHODS A retrospective review was undertaken in patients =>65 years hospitalised following an Emergency Department attendance between 1st July 2022 and 31st March 2023. Predictive models were evaluated with correlation and measure of agreement between frailty risk scores, CFS and HFRS, CFS and modified HFRS (mHFRS) using the Spearman's rank correlation and Cohen's kappa (κ). RESULTS Of 3042 patients, CFS categorised 1635 (53.7%) patients as non-frail (CFS 1-4) and 1407 (46.3%) as frail (CFS 5-9,p<0.001). Frail patients were more likely to be female (55.9%), older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p<0.001), with longer LOS (52.5% % vs 31.5%, p<0.001), higher 30-day emergency re-admission (18.5% vs 9.9%, p<0.001) and higher mortality at all time points. We could compute mHFRS for 1623 (53.4%) patients, of whom, 37.5% were low risk, 40.5% intermediate risk and 22.1% high frailty risk. mHFRS showed significant correlation with CFS (p<0.001) and HFRS (p<0.001), respectively and achieved comparable association with clinical outcomes. CONCLUSION mHFRS was better at identifying non-frail patients and provides a novel, standardised and comparable frailty risk stratification tool for screening older hospitalised patients.