Self-rated health as a proxy for frailty in older adults at emergency departments

Ebony Lewis1, Dr Magnolia Cardona-Morrell1, Dr Hatem  Alkhouri2, Professor Ken Hillman1,3

1The Simpson Centre for Health Services Research SWS Clinical School and the Ingham Institute for Applied Medical Research. University Of New South Wales , Liverpool, Australia, 2Agency for Clinical Innovation, Emergency Care Institute , Sydney , Australia, 3Liverpool Hospital Intensive Care Unit , Liverpool, Australia

Background: Despite the availability of screening tools to measure frailty, in the busy emergency department environment staff are restricted to measure objectively the parameters of existing tools. Therefore a rapid, practical instrument is required. Aims: To determine if self-rated health could be used as a proxy for frailty on admission and as a high-risk flag for people who will need community support post hospital discharge. Methods: Nurse-measured frailty scores using The Clinical Frailty Scale on consecutive older patients from a cohort 65+years admitted via emergency departments during business hours to four large Australian teaching hospitals. Frailty assessment repeated over the telephone at around three months post admission. Logistic regression used to examine associations controlling for sociodemographic and clinical parameters. Results: Within the cohort, 889 (88%) of patients (51.4% female) with mean and median age 80 years had data at baseline and follow-up. Preliminary results showed that a FairPoor self-rated health was significantly associated with baseline frailty in univariate analysis (OR 3.82, 95%CI 2.89-5.06). After adjusting for age, sex and comorbidities, FairPoor self-rated health had a strong and statistically significant association with frailty (OR 4.02, 95%CI 2.92-5.52 p<0.001). Self-rated health on admission was also an independent predictor of needing community services at follow–up (OR 1.79, 95%CI 1.33-2.42 p<0.001). Conclusion: FairPoor self-rated health on admission may be a useful proxy for frailty in the emergency department environment where comprehensive frailty instruments cannot be fully administered. It could also guide clinicians to anticipate the need for community services at discharge.


Has come from a background of Emergency Nursing and in 2014 completed a Master of International Public Health (MIPH) at the University of New South Wales.Her main interests are End-Of-Life Care, International Health and Non-Communicable Disease Prevention.