Lopez, Derrick, Murray, Kevin, Preen, David, Sanfilippo, Frank, Trevenen, Michelle, Hankey, Graeme, Yeap, Bu B, Golledge, Jonathan, Almeida, Osvaldo, and Flicker, Leon (2022) The Hospital Frailty Risk Score identifies fewer cases of frailty in a community-based cohort of older men than the FRAIL Scale and Frailty Index. The Journal of the American Medical Directors Association, 23 (8). pp. 1348-1353.

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Abstract

Objectives: The recently developed Hospital Frailty Risk Score (HFRS) allows ascertainment of frailty from administrative data. We aimed to compare the HFRS against the widely used FRAIL Scale and Frailty Index.

Design: Population-based cohort study linked to Western Australian Hospital Morbidity Data Collection and Death Registrations.

Setting and participants: The Health in Men Study with frailty determined at wave 2 (2001/2004), mortality in the 1-year period following wave 2, and disability at wave 3 (2008). Participants were 4228 community-based men aged ≥75 years, followed until wave 3.

Measurements: We used multivariable regression to determine the association between each frailty measure and outcomes of length of stay (LOS), death, and disability. We also determined if the additional cases of frailty identified by one measure over the other was associated with these outcomes.

Results: Of 4228 men studied, the HFRS (n = 689) identified fewer men as frail than the FRAIL Scale (n = 1648) and Frailty Index (n = 1820). In the fully adjusted models, all 3 frailty measures were associated with longer LOS and mortality, whereas only the FRAIL Scale and Frailty Index were significantly associated with disability. The additional cases of frailty identified by the FRAIL Scale and Frailty Index had longer LOS and greater risks of death and disability. The fully adjusted hazard ratio for death among the additional cases of frailty identified by the FRAIL Scale (compared to being not frail on both HFRS and FRAIL Scale) was 2.14 (95% CI 1.48-3.08).

Conclusions and implications: The HFRS is associated with adverse outcomes. However, it identified approximately 60% fewer men who were frail than the FRAIL Scale and Frailty Index, and the additional cases identified were also at high risks of adverse outcomes. Users of the HFRS should be aware of the differences with other frailty measures.

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