Frailty Deterioration in Medical Inpatients: Association with Length of Stay and Therapy Input

Introduction
Frailty is a key predictor of adverse outcomes in hospitalised older adults. Assessing change in Clinical Frailty Score (CFS) from admission to discharge may reflect inpatient functional decline and quality of care.

Method
A retrospective audit of 40 medical inpatients was conducted at a district general hospital. Frailty was assessed using the Rockwood Clinical Frailty Scale at admission and discharge, with input from the multidisciplinary team including occupational therapists and nursing staff. Admission source (e.g., home, care home) and discharge destination (e.g., home, community hospital, nursing home) were recorded. Primary diagnosis, presence of dementia and delirium, length of stay, and physiotherapy/occupational therapy (PT/OT) involvement were analysed in relation to change in CFS.
 

Results
Forty patients were included. CFS increased from admission to discharge in 73% of patients (29/40), indicating inpatient deconditioning. Prolonged length of stay (>2 weeks) occurred in 58% (23/40) and was associated with greater likelihood of CFS increase. PT/OT input was absent in 63% (25/40), and this group showed a higher tendency towards worsening frailty. Patients with delirium or pre-existing cognitive impairment appeared more likely to demonstrate CFS increase. A proportion of patients required higher-dependency discharge destinations compared with their admission source.
 

Conclusion
A substantial proportion of medical inpatients experience deconditioning with worsening frailty between admission and discharge, particularly with prolonged stay, limited therapy involvement, and cognitive vulnerability. Early multidisciplinary input and consistent frailty assessment may help mitigate inpatient deconditioning. A quality improvement initiative focusing on increased and earlier therapy input is planned, with subsequent re-audit to assess impact.