Background: Frailty is a complex syndrome of vulnerability and physiological decline that can occur in some individuals alongside ageing or in the context of chronic disease and multimorbidity. The Western Sydney Clinical Frailty Registry was established to provide a baseline clinical profile of patients with frailty admitted to Rehabilitation and Aged Care services and longitudinal outcome data.
Objective: To report the baseline profile, clinical management, and mortality rate, time to first all-cause rehospitalisation, residential status at 12 months for adults enrolled into the Western Sydney Clinical Frailty Registry.
Design and Methods: The Western Sydney Clinical Frailty Registry is a prospective observational cohort study of adults admitted to the Rehabilitation and Aged Care Department at Blacktown and Mount Druitt Hospitals (a 570-bed, two-site district general hospital, located in NSW, Australia). Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient at the study sites and followed up for 12 months including baseline visits and three-, six- and 12-month follow-ups via telephone interviews, there is opportunity for future data linkage studies. The primary outcome of this study was time to first rehospitalisation (including emergency department visits) and/or mortality at 12 months.
Results: 592 participants had 12-month outcome data available and were included in the analyses. The median age was 82 (IQR: 76 -86) years, almost 60% percent of participants were Female, and English was the primary language spoken. Most of this cohort were frail with 50% classified as mild-moderately frail and 21% classified as severely frail. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p <0.001) and Clinical Frailty Scale (CFS) scores (p <0.001). The independent predictors of the composite outcome were CFS frailty group, Charlson score group and sex. Compared to the ‘non- frail’ group (CFS 1-4), those who were severely frail (CFS 7-9) had an 85% increased risk of rehospitalisation and/or death, and those who were mild-moderately frail (CFS 5-6) had a 52% increased risk after adjusting for effects of the other variables.
Conclusions: Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.