What do we know about frailty in the acute care setting? A scoping review

Theou, Olga; Squires, Emma; Mallery, Kayla; Lee, Jacques S.; Fay, Sherri; Goldstein, Judah; Armstrong, Joshua J.; Rockwood, Kenneth

doi:10.1186/s12877-018-0823-2

BMC Geriatrics

Table 2 Frailty charactseristics of included articles

From: What do we know about frailty in the acute care setting? A scoping review

	All	Geriatrics	Emergency Department	General Medicine	Cardiology	Orthopedics	Intensive Care Unit	Oncology	Surgery	Prehospital	General Medicine & Surgery	General Medicine & Geriatrics	Geriatrics & Oncology
Articles n (%)	240 (100)	29 (12.1)	29 (12.1)	22 (9.2)	20 (8.3)	11 (4.6)	9 (3.8)	6 (3)	5 (2.1)	2 (0.8)	18 (7.5)	7 (2.9)	2 (0.8)
When was frailty measured n (%)
At admission	94 (46.1)	15 (51.7)	18 (62.1)	12 (54.5)	6 (30.0)	3 (27.3)	5 (55.6)	3 (50.0)	3 (60.0)	0	3 (16.7)	6 (85.7)	1 (50.0)
During hospitalization	34 (16.7)	9 (31.0)	3 (10.3)	5 (22.7)	4 (20.0)	2 (18.2)	1 (11.1)	2 (33.3)	0	1 (50.0)	3 (16.7)	0	0
At discharge	10 (4.9)	1 (3.4)	1 (3.4)	0	3 (15.0)	0	1 (11.1)	0	0	0	0	0	0
Mixed^a	13 (6.4)	1 (3.4)	3 (10.3)	2 (9.0)	0	1 (9.1)	0	1 (16.7)	0	0	0	1 (14.3)	0
Chart/Database review	27 (13.2)	3 (10.3)	3 (10.3)	2 (9.1)	6 (30.0)	3 (27.3)	2 (22.2)	0	1 (20.0)	1 (50.0)	1 (5.6)	0	0
Not reported	26 (12.7)	0	1 (3.4)	1 (4.5)	1 (5.0)	2 (18.2)	0	0	1 (20.0)	0	11 (61.1)	0	1 (50.0)
Number of frailty measures used n (%)
1	185 (90.7)	25 (86.2)	27 (93.1)	21 (95.5)	16 (80.0)	8 (72.7)	8 (88.9)	6 (100.0)	4 (80.0)	2 (100.0)	18 (100.0)	7 (100.0)	2 (100.0)
2	9 (4.4)	3 (10.3)	0	0	4 (20.0)	0	1 (11.1)	0	0	0	0	0	0
3	5 (2.5)	0	2 (6.9)	1 (4.5)	0	2 (18.2)	0	0	0	0	0	0	0
4	4 (2.0)	1 (3.4)	0	0	0	1 (9.1)	0	0	0	0	0	0	0
6	1 (0.5)	0	0	0	0	0	0	0	1 (20.0)	0	0	0	0
Type of frailty measure n (%)
Established frailty tools	123 (51.3)	17 (48.6)	17 (51.5)	17 (70.8)	16 (66.7)	6 (33.3)	9 (90.0)	3 (50.0)	6 (60.0)	1 (50.0)	0	6 (85.7)	1 (50.0)
Non-frailty tools^b	57 (23.8)	11 (31.4)	13 (39.4)	4 (16.7)	3 (12.5)	10 (55.6)	0	1 (16.7)	4 (40.0)	0	1 (5.6)	0	0
Ad hoc measures^c	56 (23.3)	6 (17.1)	3 (9.1)	3 (12.5)	4 (16.7)	2 (11.1)	1 (10.0)	2 (33.3)	0	1 (50.0)	15 (83.3)	1 (14.3)	1 (50.0)
Clinical judgment	4 (1.7)	1 (2.9)	0	0	1 (4.2)	0	0	0	0	0	2 (11.1)	0	0
Frailty Measure used n (%)
Established frailty tools
Clinical Frailty Scale	28 (11.7)	6 (17.1)	4 (12.1)	4 (16.7)	3 (12.5)	0	6 (60.0)	0	0	0	0	0	0
Frailty Phenotype	28 (11.7)	2 (5.7)	4 (12.1)	4 (16.7)	6 (25.0)	1 (5.6)	2 (20.0)	0	2 (20.0)	0	0	1 (14.3)	0
Frailty Index	28 (11.7)	3 (8.6)	7 (21.2)	4 (16.7)	1 (4.2)	4 (22.2)	1 (10.0)	0	1 (10.0)	1 (50.0)	0	1 (14.3)	0
Edmonton Frailty Scale	10 (4.2)	0	2 (6.1)	2 (8.3)	2 (8.3)	1 (5.6)	0	0	0	0	0	0	0
Winodgrad Index	7 (2.9)	0	0	1 (4.2	0	0	0	0	0	0	0	4 (57.1)	0
Balducci criteria	5 (2.1)	0	0	0	0	0	0	3 (50.0)	1 (10.0)	0	0	0	1 (50.0)
Rockwood Geriatric Frailty Status	5 (2.1)	2 (5.7)	0	0	1 (4.2)	0	0	0	1 (10.0)	0	0	0	0
Study of Osteoporotic Fracture Index	3 (1.3)	2 (5.7)	0	1 (4.2)	0	0	0	0	0	0	0	0	0
Tilburg Frailty Indicator	3 (1.3)	0	0	1 (4.2)	2 (8.3)	0	0	0	0	0	0	0	0
FRAIL scale	2 (0.8)	1 (2.9)	0	0	1 (4.2)	0	0	0	0	0	0	0	0
Groningen Frailty Indicator	2 (0.8)	0	0	0	0	0	0	0	1 (10.0)	0	0	0	0
Other established tools^d	2 (0.8)	1 (2.9)	0	0	0	0	0	0	0	0	0	0	0
Non-frailty tools^b
Identification of Seniors at Risk	12 (5.0)	4 (11.4)	3 (9.1)	2 (8.3)	1 (4.2)	1 (5.6)	0	0	0	0	0	0	0
Vulnerable Elders Survey	5 (2.1)	0	3 (9.1)	0	0	0	0	0	1 (10.0)	0	0	0	0
Grip strength	4 (1.7)	2 (5.7)	0	0	0	1 (5.6)	0	0	0	0	0	0	0
Barthel Index	2 (0.8)	0	2 (6.1)	0	0	0	0	0	0	0	0	0	0
Life Space Assessment	2 (0.8)	0	2 (6.1)	0	0	0	0	0	0	0	0	0	0
Multidimensional Prognosis Index	2 (0.8)	2 (5.7)	0	0	0	0	0	0	0	0	0	0	0
Short Physical Performance Battery	2 (0.8)	1 (2.9)	0	0	0	0	0	1 (16.7)	0	0	0	0	0
Other non-frailty tools^e	28 (11.7)	2 (5.7)	3 (9.1)	2 (9.1)	2 (8.3)	8 (44.4)	0	0	3 (30.0)	0	1 (5.6)	0	0
Ad hoc measures^c
GEM criteria^f	12 (5.0)	0	0	0	0	0	0	0	0	0	12 (66.7)	0	0
Other ad hoc measures	44 (18.3)	6 (17.1)	3 (9.1)	3 (12.5)	4 (16.7)	2 (11.1)	1 (10.0)	2 (33.3)	0	1 (50.0)	3 (16.7)	1 (14.3)	1 (50.0)
Clinical judgment	4 (1.7)	1 (2.9)	0	0	1 (4.2)	0	0	0	0	0	2 (11.1)	0	0
Purpose of frailty use n (%)
Risk stratification^g	89 (43.6)	12 (41.4)	15 (51.7)	10 (45.5)	11 (55.0)	8 (72.7)	8 (88.9)	2 (33.3)	2 (40.0)	1 (50.0)	3 (16.7)	2 (28.6)	0
Inclusion/Exclusion criterion	41 (20.1)	4 (13.8)	3 (10.3)	4 (18.2)	1 (5.0)	0	0	0	1 (20.0)	1 (50.0)	13 (72.2)	5 (71.4)	0
Outcome measure	4 (2.0)	1 (3.4)	1 (3.4)	0	1 (5.0)	1 (9.1)	0	0	0	0	0	0	0
Mixed^h	3 (1.5)	0	0	2 (9.0)	0	0	0	1 (16.7)	0	0	0	0	0
Only descriptiveⁱ	67 (32.8)	12 (41.4)	10 (34.5)	6 (27.3)	7 (35.0)	2 (18.2)	1 (11.1)	3 (50.0)	2 (40.0)	0	2 (11.1)	0	2 (100.0)
Prevalence of frailty (%)
# of articles reporting	122	17	13	12	17	5	8	5	7	0	4	2	1
Range	1.1–100	1.1–90.0	6.9–78.0	23.0–77.9	4.7–77.8	11.4–89.4	13.7–100	19.1–96.7	29.3–79.9	N/A	30.3–91.0	41.4–59.0	26.0
Median (IQR)	48.5 (32.0–69.5)	43.3 (26.9–70.7)	46.7 (34.2–70.2)	51.3 (34.8–55.2)	35.5 (28.7–69)	68.5 (31.2–89.4)	33.5 (25.3–47.0	41.4 (26.7–81.0)	54.3 (50.0–70.7)	N/A	45.3 (32.2–81.4)	N/A	N/A
Adverse outcomes predicted by frailty [n predicted/total measured (% predictive)]^j
All adverse outcomes	169/228 (74.1)	23/30 (69.7)	25/32 (78.1)	18/22 (81.8)	15/19 (78.9)	11/16 (68.8)	22/33 (66.7)	4/8 (50)	11/14 (78.6)	1/1 (100)	4/4 (100)	2/3 (66.7)	0
Mortality	58/69 (84.1)	13/14 (92.9)	6/7 (85.7)	4/4 (100.0)	7/10 (70.0)	4/5 (80.0)	6/8 (75.0)	1/2 (50.0)	6/7 (85.7)	1/1 (100.0)	0	0	0
Length of stay	24/33 (72.7)	3/5 (60.0)	4/5 (80.0)	4/7 (57.1)	2/2 (100.0)	3/3 (100.0)	3/6 (50.0)	0	0	0	1/1 (100.0)	2/2 (100.0)	0
In-hospital complications	20/29 (69.0)	0	2/2 (100.0)	0	2/2 (100.0)	1/4 (25.0)	1/3 (33.3)	1/2 (50.0)	5/7 (71.4)	0	1/1 (100.0)	0	0
Institutionalization	27/29 (93.1)	1/1 (100.0)	6/6 (100.0)	7/7 (100.0)	1/1 (100.0)	1/1 (100.0)	5/7 (71.4)	1/1 (100.0)	0	0	0	0	0
Rehospitalization	9/18 (50.0)	3/4 (75.0)	3/5 (60.0)	0/1 (0)	1/1 (100.0)	0	0/1 (0)	0	0	0	1/1 (100.0)	0	0
Functional decline	8/8 (66.7)	2/2 (100.0)	2/4 (50.0)	1/1 (100.0)	0	0	3/3 (100.0)	0	0	0	0	0/1 (0)	0
Treatment change^k	8/8 (66.7)	1/1 (100.0)	0/1 (0)	0	2/3 (66.7)	0	2/3 (66.7)	0/1 (0)	0	0	1/1 (100.0)	0	0
Falls	3/7 (42.9)	0/4 (0)	1/1 (100.0)	0	0	0	0	0	0	0	0	0	0
Delirium	1/4 (25.0)	0/2 (0)	0	1/1 (100.0)	0	0/1 (0)	0	0	0	0	0	0	0
Treatment response^l	4/4 (100.0)	0	0	1/1 (100.0)	0	0	0	1/1 (100.0)	0	0	0	0	0
Cognitive decline	0/3 (0)	0	0	0	0	0	0	0	0	0	0	0	0
Quality of life	2/2 (100.0)	0	0	0	0	1/1 (100.0)	1/1 (100.0)	0	0	0	0	0	0
Other^m	5/6 (83.3)	0	1/2 (50.0)	0	0	1/1 (100.0)	1/1 (100.0)	0	0	0	0	0	0

We only stratified by disciplines that have been included in at least 2 articles
N/A not applicable, # number, IQR interquartile range
^aMultiple testings for each patient or different testing times for subgroup of patients
^bTools that were not developed specifically for measuring frailty
^cOperationalized definitions of frailty (for example, ≥65 years of age plus 3 comorbidities)
^dClinical Global Impression of Change in Physical Frailty; Geriatrician Clinical Impression of Frailty
^eNon-frailty tools that were used only once
^fThe Geriatric Evaluation and Management (GEM) drug study criterion was meeting at least 2 of the following 10 criteria: dependence in at least one activity of daily living, stroke within 3 months, previous falls, difficulty ambulating, malnutrition, dementia, depression, unplanned admission in the last 3 months, prolonged bed rest, or incontinence
^gArticles that examined the association of a frailty measure with a longitudinal adverse outcome
^hInclusion/Exclusions criterion and outcome measure; risk stratification and outcome measure
ⁱArticles which only used frailty as a descriptive characteristic. For example, if an article used frailty both as an inclusion/exclusion criterion and a descriptive characteristic, it was only categorized as inclusion/exclusion criterion in our review
^jMore than one outcome can be examined within each article
^kFor example, change in anticoagulant use
^lFor example, antibody levels
^mAdverse outcomes that were examined only once

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