title: Clinical frailty and functional trajectories in hospitalized older adults: A retrospective observational study.
abstract: OBJECTIVE
  Frailty predicts inpatient mortality and length of stay, but its link to functional trajectories is under-researched. Addenbrooke's Hospital, Cambridge, UK, collects the Clinical Frailty Scale (CFS) within 72 h of admission for those aged ≥75 years. We studied whether the CFS links to functional trajectories in hospitalized older adults.
  
  
  METHODS
  This was a retrospective observational study in an English university hospital. We analyzed all first episodes of county residents aged ≥75 years admitted to the Department of Medicine for the Elderly wards between December 2014 and May 2015. Data were extracted from the hospital's information systems. Patients were classified as non-frail (CFS 1-4), moderately frail (CFS 5-6) and severely frail (CFS 7-8). Function was retrospectively measured with the modified Rankin Scale (mRS) at preadmission, admission and discharge.
  
  
  RESULTS
  Of 539 eligible patients, 46 died during admission (mortality rates: 2% in CFS 1-4, 5% in CFS 5-6, 19% in CFS 7-8). Among the 493 survivors, 121 were non-frail, 235 moderately and 137 severely frail. The mean mRS of the non-frail was 1.8 (95% CI 1.7-2.0) at baseline, 3.3 (95% CI 3.1-3.5) on admission and 2.2 (95% CI 2.0-2.3) on discharge (mean length of stay 9 days). The moderately frail had a mean mRS of 2.9 (95% CI 2.8-3.0) at baseline, 4.0 (95% CI 3.8-4.1) on admission and 3.2 (95% CI 3.1-3.3) on discharge (mean length of stay 15 days). The severely frail had mean mRS of 3.5 (95% CI 3.3-3.6) at baseline, 4.3 (95% CI 4.1-4.4) on admission and 3.7 (95% CI 3.6-3.9) on discharge, respectively (mean length of stay 17 days).
  
  
  CONCLUSIONS
  In older inpatients, frailty might be linked to lower and slower functional recovery. Prospective work is required to confirm these trajectories and understand how to influence them. Geriatr Gerontol Int 2017; 17: 1063-1068.
authors.affiliation: Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Hartley
authors.affiliation: Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adamson
authors.affiliation: Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Physiotherapy, Luton and Dunstable Hospital, Luton, United Kingdom.
authors.forename: Georgina
authors.initials: G
authors.lastname: Embleton
authors.affiliation: Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom.|Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Roman
authors.initials: R
authors.lastname: Romero-Ortuno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004739:England; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000175:diagnosis / Q000453:epidemiology*; D015577:Geriatric Assessment; D006305:Health Status Indicators; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: Clinical Frailty Scale; disability; frail elderly; functional trajectory; hospital medicine