9 * A SIMPLE SCORE TO IDENTIFY FRAIL OLDER PATIENTS

Background: Many scales are used to identify frail patients based on strength, exercise capacity or recent weight loss or on multiple indices. With our Commissioners we are attempting to perform Comprehensive Geriatric Assessments on a higher proportion of Frail Patients admitted to hospital. We needed a scale that could rapidly be calculated from routinely collected data on admission. The Rockwood Scale (Rockwood K et al. CMAJ 2005;173:489) is commonly used and is a subjective seven-level scale ranging from very fit to severely frail scored by the examining clinician based on the patient's assessment of exercise capacity and Activities of Daily Living. Different centres use other approaches: e.g. Leicester have found that “falls, cognitive impairment and admitted from a care home” identify 80–90% of frail patients. Innovation: One of us (CN) obtained the Rockwood Score on 63 consecutive over 75 year old patients admitted as an emergency and simultaneously calculated the “Leicester Frailty Index” scoring 1 each if there was a history of falls, if there was cognitive impairment (Abbreviated Four item Mental Test Score <4) or admission from a care home. All these data are routinely recorded in our admission clerking. The maximum score was 3 and a score greater than 0 indicated frailty. The Rockwood Score was compared to the Leicester Frailty Index by calculating the kappa statistic using Statistical Package for Social Sciences (SPSS.)