• Vol. 48 No. 4, 115–124
  • 15 April 2019

Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults



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We developed a Clinical Frailty Scale algorithm (CFS-A) to minimise interrater variability and to facilitate wider application across clinical settings. We compared the agreement, diagnostic performance and predictive utility of CFS-A against standard CFS. Materials and Methods: We retrospectively analysed data of 210 hospitalised older adults (mean age, 89.4 years). Two independent raters assessed frailty using CFS-A. Agreement between CFS-A raters and with previously completed CFS was determined using Cohen’s Kappa. Area under receiver operator characteristic curves (AUC) for both measures were compared against the Frailty Index (FI). Independent associations between these measures and adverse outcomes were examined using logistic regression. Results: Frailty prevalence were 81% in CFS and 96% in CFS-A. Inter-rater agreement between CFS-A raters was excellent (kappa 0.90, P <0.001) and there was moderate agreement between CFS-A and standard CFS (kappa 0.42, P <0.001). We found no difference in AUC against FI between CFS (0.91; 95% CI, 0.86-0.95) and CFS-A (0.89; 95% CI, 0.84-0.95; P <0.001). Both CFS (OR, 3.59; 95% CI, 2.28-5.67; P <0.001) and CFS-A (OR, 4.31; 95% CI, 2.41-7.69; P <0.001) were good predictors of mortality at 12 months. Similarly, CFS (OR, 2.59; 95% CI, 1.81-3.69; P <0.001) and CFS-A (OR, 3.58; 95% CI, 2.13-6.02; P <0.001) were also good predictors of institutionalisation and/or mortality after adjusting for age, sex and illness severity. Conclusion: Our study corroborated the results on interrater reliability, diagnostic performance and predictive validity of CFS-A which has the potential for consistent and efficient administration of CFS in acute care settings.

Singapore is ageing at an exponential rate. Commensurate with the worldwide trend of population ageing, 13% of residents were aged 65 years and older in 2017 with a life expectancy of 83.1 years.1 By 2030, the aged population is projected to constitute approximately 25% of its total population with the cost of providing care to older adults rising to US$49 billion (S$66 billion) annually and an average cost of US$37,427 for each older person.1,2 Therefore, it is imperative that healthcare services across Singapore become frailty-ready to face and embrace the growing challenges of caring for older adults.

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