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A new study has shown the need for more widespread screening for frailty in unplanned admissions to hospitals to better inform the care received by patients.

A young person's hand on an older person's hand

Researchers from our Wolfson Centre for the Prevention of Stroke and Dementia, supported by the NIHR Oxford Biomedical Research Centre, carried out a systematic review of studies on a total of 39 million patients with unplanned hospital admission, predominantly to acute general medicine.

The study, published in the journal eClinicalMedicine, showed that frailty was consistently associated with increased mortality, increased length of stay in hospital and discharge to a location other than home.

The findings come as a new NHS Commissioning for Quality and Innovation (CQUIN) framework includes a requirement relating to the identification and response to frailty in emergency departments.

The study's principal investigator, Professor Sarah Pendlebury, said: 'The idea underpinning the CQUIN is that these vulnerable patients are screened for frailty and referred for appropriate assessment. This approach is supported by our research, which shows there should be more widespread screening for both the presence and severity of frailty with simple clinically administered tools – such as the NHS-recommended Clinical Frailty Tool - to inform care and target comprehensive geriatric assessment and interventions.'

The area of older people with complex conditions is not well understood by the general public, compared to discrete diseases or conditions relating to a single organ. Nevertheless, more than 4,000 patients are admitted to hospital in England every day as a result of frailty, and with an ageing population, these numbers continue to rise.

Frailty is associated with increased vulnerability to illness, reduced quality of life and poor health outcomes and its importance has been highlighted in the recent NHS England Getting It Right First Time (GIRFT) report on geriatric medicine.

While there has been some research done on frailty in older patients in the community or in very specific hospital populations, such as those undergoing planned surgery, there was relatively little data collated on people with unplanned hospital admissions.

'People have to be quite ill to be admitted to hospital, so it could be argued that the frailty might be less important in predicting outcomes, and that factors such as the severity of the illness and co-morbidities might be more important. But our evidence suggests is that is not the case; frailty is predictive over and above those factors and there also seems to be a 'dose response' – the frailer you are, the more likely you are to have a bad outcome,' Professor Pendlebury, a Consultant Physician at OUH and Professor of Medicine and Old Age Neuroscience, explained.

Dr Sudhir Singh, OUH Clinical Director for Acute Medicine, said: 'This research is very timely as the NHS tries to improve care pathways for our most vulnerable patients and our Trust has adopted frailty as a Trust quality priority for 2023/24. Emergency department clinicians and those working in acute medicine are incredibly busy, which is why a simple and rapid assessment is needed. This study shows that even doing a quick and simple test is extremely useful in identifying those patients at greatest risk of further deterioration.

'If we understand their underlying frailty, it will inform the prognosis and influence clinical decisions during admission: for example, around treatment, resuscitation or future readmissions. And for less frail patients, we can take steps during admission to improve their outcomes – such as around their mobility and nutrition, or addressing delirium, if they have it – by making their care as individualised and as optimal as possible.'