Clinical Interventions in Aging (Jul 2024)
The Association Between Frailty Evaluated by Clinical Frailty Scale and Mortality of Older Patients in the Emergency Department: A Prospective Cohort Study
Abstract
Jin-Wei Lin,1– 3 Pei-Ying Lin,1,2 Tse-Yao Wang,1,2 Ying-Ju Chen,1,2 David Hung-Tsang Yen,1– 5 Hsien-Hao Huang1– 3 1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan; 5Chang Bing Show-Chwan Memorial Hospital, Changhua City, TaiwanCorrespondence: Hsien-Hao Huang, Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei, 112201, Taiwan, Email [email protected]: Frailty epitomizes the most complex consequence of an aging population. This study aimed to evaluate the impact of frailty, measured using the Clinical Frailty Scale (CFS), on outcomes of older people in an emergency department (ED).Methods: We conducted a prospective observational study enrolling patients aged 65 years and older in a medical center of Taiwan between March 8, 2021, and November 30, 2021. The primary outcome was 90-day mortality rate. Individuals were categorized into three groups based on the CFS scores. Logistic regression was employed to examine the influence of frailty on clinical outcomes following covariate adjustment. Survival analysis was conducted using Kaplan–Meier curves and Log rank tests.Results: A total of 473 individuals were included in the study, with a mean age of 82.1 years, and 60.5% of them were males. The 90-day mortality rate was 10.6%. Among these groups, the CFS score 7– 9 group had the highest 90-day mortality rate (15.9%), followed by the CFS score 4– 6 group (8.0%) and the CFS score 1– 3 group (7.1%). The multiple logistic regression analyses demonstrated a significant impact of CFS score on prognosis, with adjusted odd ratios of 1.24 (95% CI 1.06– 1.47) for 90-day mortality, 1.18 (95% CI 1.06– 1.31) for hospitalization, and 1.30 (95% CI 1.12– 1.52) for 180-day mortality. The Kaplan–Meier curves revealed a significantly higher 90-day mortality rate for patients with high CFS scores (Log rank tests, p = 0.019).Conclusion: In the older ED population, the severity of frailty assessed by the CFS emerged as a significant and important prognostic factor for hospitalization, 90-day mortality, and 180-day mortality.Keywords: frailty, emergency service, hospital, triage, mortality
