Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden.
Clin Interv Aging. 2023 Feb 18;18:249-261. doi: 10.2147/CIA.S388160. eCollection 2023.
Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.
To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings.
Systematic review with narrative synthesis.
Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020.
Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.
A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
虚弱的老年人健康状况较差的风险更高。因此，在护理过程早期评估预住院期的虚弱程度对于识别最脆弱的患者并确定其病情恶化的风险至关重要。临床虚弱量表（CFS）是一种评估预住院期移动能力、能量、身体活动和功能的虚弱评估工具，其评分范围从非常健康到生命垂危。
综合评估 CFS 程度与 65 岁以上急性临床环境中所有原因死亡率、所有原因再入院率、住院时间、不良出院目的地和功能下降之间关联的证据。
系统综述，文字综合。
从数据库建立到 2020 年 4 月，电子数据库（PubMed、EMBASE、CINAHL、Scopus）检索前瞻性或回顾性研究，报告根据 CFS 评估的预住院期虚弱程度与感兴趣结局之间的关系。
我们的搜索结果产生了 756 篇文章，其中 29 项研究纳入本综述（15 项研究为中度偏倚风险，14 项研究为低偏倚风险）。纳入的研究代表了来自 25 个国家的 26 个队列（N = 44166），发表时间为 2011 年至 2020 年。所有纳入的研究均表明，根据 CFS 评估的预住院期虚弱程度是综述中所有不良健康结局的独立预测因素。
CFS 的主要目的是对临床增加的风险进行分级（即风险分层）。我们的结果报告了 CFS 风险预测性能的累积知识，并强调了常规进行虚弱评估（如 CFS）的重要性，以估计生物学年龄、改善风险评估，并帮助急性护理中的老年患者做出临床决策。需要进一步研究 CFS 的潜力以及在常规实践中实施 CFS 是否会改善护理和患者的生活质量。
