Delirium and Frailty Assessment Across Acute and Community Hospitals: A Service Evaluation​

Background: Delirium and frailty are common, interrelated syndromes in older adults and are associated with adverse outcomes including longer hospital stay, functional decline and mortality. National guidance recommends early delirium assessment using the 4AT and frailty assessment using the Clinical Frailty Scale (CFS). We evaluated delirium and frailty assessment across acute and community hospital settings within NHS Grampian.

Methods: A retrospective review of 60 consecutive completed admissions of adults aged ≥65 years was undertaken: 30 from Aberdeen Royal Infirmary (ARI) Ward 102, an acute geriatric receiving ward, and 30 from Peterhead Community Hospital (Summers Ward). Outcomes included 4AT completion, delirium recognition and management, and CFS documentation.

Results: In ARI Ward 102, 17/30 older adults (57%) received a 4AT within 24 hours of hospital arrival. Delirium was identified in 18/30 (60%), including 10 with a positive 4AT and 8 diagnosed clinically despite absent or negative screening. Following delirium recognition, reversible causes were investigated in all cases, delirium was documented in 16/18, and a TIME bundle was recorded in 14/18. Formal re-assessment using the 4AT occurred in one patient. CFS was documented in 17/30 (57%), with most recorded scores indicating moderate to severe frailty.

In Peterhead Community Hospital, no older adults received a 4AT within 24 hours of admission and only 2/30 had any documented 4AT during admission. However, clinical features consistent with delirium were described in 12/30 (40%), suggesting informal recognition without structured assessment. CFS was documented in 8/30 (27%), most commonly from acute hospital records rather than community reassessment.

Conclusions: Delirium and frailty were frequently recognised among older adults but were inconsistently documented using validated assessment tools, particularly following transfer to community hospital care. Improving visibility and ownership of structured assessment at care transitions may enhance continuity, monitoring and multidisciplinary communication across the acute-community pathway.