The Implementation of Frailty Assessment Tools in the Acute Care Setting: A Scoping Review

BACKGROUND: Frailty is a syndrome of increased vulnerability to health stressors that is associated with adverse health outcomes. There is no universally accepted method of measuring frailty, and choosing among the many tools is often confusing for clinicians. Moreover, the acute care setting presents unique challenges to the operationalization of frailty measurement, and implementation into daily clinical practice has been variable. The objective of this scoping review was to map out and synthesize how frailty is being measured and used in the acute care setting. METHODS: We used Arksey and O'Malley's methodological framework for scoping reviews. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and Google Scholar for primary studies assessing frailty in the acute care setting from inception to May 2023. RESULTS: Our search resulted in 8834 articles, of which 2554 met inclusion criteria. Most articles (75%) were published in the last 5 years. The top three most frequently used methods of frailty measurement were the Frailty Index (41.0%), the Clinical Frailty Scale (23.3%), and the Fried Frailty Phenotype (9.3%). More than one frailty assessment tool was used in 11.2% of studies. While 99.6% of studies measured frailty assessment to evaluate the association of frailty with adverse outcomes or the validity of specific frailty tools, only 0.4% measured frailty to prospectively adapt healthcare provision. CONCLUSION: There is an abundance of evidence demonstrating that frailty in acute care is associated with adverse health outcomes, with relatively scarce evidence on the effect of frailty assessment on prospectively adapting care. Future research focusing on the prospective management of frailty in acute care is needed.