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Introduction: Older people are at an increased risk of adverse outcomes following attendance at acute hospitals. It has been proposed that using screening tools may help identify those most at risk. The objective of this study was to compare the predictive properties of five frailty-rating scales to assess whether they play a role in risk stratification.

Methods: This was a secondary analysis of a cohort of participants aged 70 years and above attending two acute medical units in the East Midlands, UK. Five different frailty-rating scales were created and the participants were dichotomised as frail or non-frail. The predictive properties of each scale were assessed for 90-day mortality, readmissions, institutionalisation, functional decline and a composite outcome using area under a receiver operating characteristic curve (AUC).

Results: A total of 667 participants were included in this study. Frail participants according to all scales were associated with a significant increased risk in mortality [relative risk (RR) range between 1.6 and 3.1], readmission (RR range between 1.1 and 1.6), functional decline (RR range between 1.2 and 2.1) and the composite (RR range between 1.2 and 1.6). However, the predictive properties of the frailty-rating scales were poor for all outcomes assessed (AUC: 0.44–0.69).

Conclusions: The results highlight that frailty-rating scales play a limited role in risk stratifying the older population in the acute hospital setting.

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