Older people in hospital are at high risk of adverse outcomes, a vulnerability commonly referred to as frailty.

In community-dwelling older people, frailty status can be measured precisely with an index of deficits. As people age, they accumulate problems across multiple systems (e.g. medical comorbidities, functional impairments, cognitive decline and loss of vision and hearing). By applying a well-defined methodology, these problems can be coded as deficits, summed and divided by the total number of potential problems to derive a frailty index (FI) score. As a continuous variable (rather than dichotomous frail vs not frail), the FI provides a precise, individualised summary of risk status. Though it has been validated in tens of thousands of community-dwellers, the FI has been criticised as too unwieldy for the busy inpatient setting. One of our current projects is to derive an FI from information that is already routinely collected for the interRAI Acute Care instrument. Integration of frailty quantification into an existing assessment system, which serves other clinical and administrative purposes, could optimise clinical utility and minimise costs, without losing fidelity. This would assist clinicians to identify vulnerable older inpatients, improving their care in the acute setting.

Other ongoing projects include the measurement of frailty in patients with chronic kidney disease, the stratification of risk for older people needing elective or emergency surgery, investigation of sex differences in frailty and the role of assets in mitigation of risk. Students undertaking research higher degrees are affiliated to each of these sub-themes.

This work is led by Associate Professor Ruth Hubbard.