The challenges of using the Hospital Frailty Risk Score - Author's reply

We thank John Soong and colleagues, Sandra M Shi and Dae H Kim, and Rónán O'Caoimh and colleagues for their careful consideration of our Article. We note some concerns about the clinical utility of our scoring method; our approach is to position the Hospital Frailty Risk Score (HFRS) as a tool that can be implemented without the need for additional assessment or data collection, and direct high-risk individuals towards frailty-attuned interventions, such as the Comprehensive Geriatric Assessment (CGA).1 We acknowledge that the HFRS can only be generated after an initial admission, so risk stratification information would not be possible at first presentation. Two-thirds of people aged 75 years or older access acute-care hospitals more than once over a 2-year period, and those patients who have not previously accessed hospital care are typically at low risk of hospital-related adverse outcomes; thus, we view the HFRS as being especially useful to identify individuals at the highest risk of hospital-related harm and resource use. We accept that manual scales, such as the Clinical Frailty Scale,2 could be used, but the HFRS has the advantage of being automated and capturing all patients, not just a selected sample

Outcomes of hospital admissions among frail older people: a 2-year cohort study.

BACKGROUND: 'Frailty crises' are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty. AIM: To determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status. DESIGN AND SETTING: Two populations aged ≥70 years discharged from hospital units: those following short 'ambulatory' admissions (<72 hours) and those following longer inpatient stays. METHOD: Data for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data. RESULTS: Mortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail. CONCLUSION: Individuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short 'ambulatory' admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a 'secondary prevention' approach to frailty crises targeting individuals who are discharged from hospital

Southampton Arm Fracture Frailty and Sarcopenia Study (SAFFSS): a study protocol for the feasibility of assessing frailty and sarcopenia among older patients with an upper limb fracture.

INTRODUCTION: Falls are a major health problem for older people; 35% of people aged 65+ years fall every year, leading to fractures in 10%-15%. Upper limb fractures are often the first sign of osteoporosis and routine screening for osteoporosis is recommended by the National Institute for Health and Care Excellence to prevent subsequent hip fractures. However, both frailty and sarcopenia (muscle weakness) are associated with increased risk of falling and fracture but are not routinely identified in this group. The aim of this study is to evaluate the feasibility of assessing and managing frailty and sarcopenia among people aged 65+ years with an upper limb fracture. METHODS AND ANALYSIS: This study will be conducted in three fracture clinics in one acute trust in England. 100 people aged 65+ years with an upper arm fracture will be recruited and assessed using six validated frailty measures and two sarcopenia tools. The prevalence of the two conditions and the best tools to use will be determined. Those with either condition will be referred to geriatric clinical teams for comprehensive geriatric assessment (CGA). We will document the proportion who are referred for CGA and those who receive CGA. Other outcome measures including falls, fractures and healthcare resource use over 6 months will be collected. In-depth interviews with a purposive sample of patients who undergo the frailty and sarcopenia assessments and healthcare professionals in fracture clinics and geriatric services will be carried out to their acceptability of assessing frailty and sarcopenia in a busy environment. ETHICS AND DISSEMINATION: The study was given the relevant ethical approvals from NHS Research Ethics Committee (REC No: 18/NE/0377), the University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Faculty of Medicine Ethics Committee and Research Governance Office. Findings will be published in scientific journals and presented to local, national and international conferences. TRIAL REGISTRATION NUMBER: ISRCTN13848445