Association Between Clinical Frailty Scale and Falls Risk in Hospitalized Older Adults: A Systematic Review and Meta-Analysis

Background:
Inpatient falls among older adults remain a major patient safety concern, contributing to morbidity, prolonged length of stay, and increased healthcare costs. Frailty is increasingly recognised as a key determinant of adverse inpatient outcomes. The Clinical Frailty Scale (CFS) is a rapid, widely used frailty assessment tool; however, its relationship with inpatient falls risk has not been systematically evaluated.

Objective:
To systematically review and synthesise the evidence on the association between Clinical Frailty Scale scores and falls risk in hospitalized older adults.

Methods:
A systematic literature search was conducted in PubMed, Google Scholar Full-Text for studies published between 2015 and 2025. PRISMA guidelines were followed. Eligible studies included hospitalized adults aged ≥65 years that examined the association between CFS and inpatient falls. Screening, eligibility assessment, and data extraction were performed using predefined criteria.

Results:
From 225 records identified, 76 unique studies were screened following duplicate removal. Seven studies underwent full-text review, of which two met inclusion criteria for qualitative synthesis. Both studies demonstrated a statistically significant association between higher CFS scores and increased risk of inpatient falls. Only one study reported sufficient quantitative data to allow consideration of meta-analysis, limiting pooled effect estimation.

Conclusion:
Available evidence, although limited, consistently demonstrates that higher Clinical Frailty Scale scores are associated with increased falls risk among hospitalized older adults. The scarcity of eligible studies and limited quantitative reporting highlight a critical evidence gap. Further prospective studies are needed to determine whether routine CFS assessment can enhance inpatient falls risk stratification and prevention strategies.