Predictive Assessment of Delirium in Elderly Frail Patients Using FRAIL，CFS，and REFS Scales: Analysis of Risk Factors

Jia TAN; Yixing ZOU; Xiaoying HAN; Guangming DING; Zhaohui LENG

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Article Navigation > Journal of Kunming Medical University > 2025 > Accepted Manuscript

Jia TAN, Yixing ZOU, Xiaoying HAN, Guangming DING, Zhaohui LENG. Predictive Assessment of Delirium in Elderly Frail Patients Using FRAIL，CFS，and REFS Scales: Analysis of Risk Factors[J]. Journal of Kunming Medical University.

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Predictive Assessment of Delirium in Elderly Frail Patients Using FRAIL，CFS，and REFS Scales: Analysis of Risk Factors

Department of Geriatrics，Chengdu Sixth People's Hospital，Chengdu Sichuan 610051，China

Available Online: 2025-12-03

Abstract

Abstract

Objective To explore the predictive assessment and risk factor analysis of the FRAIL Scale （Frailty Scale）, Clinical Frailty Scale （CFS）, and Reported Edmonton Frail Scale （REFS） for delirium in elderly frail patients. Methods A total of 187 elderly frail hospitalized patients admitted to the Department of Geriatric Medicine at Chengdu Sixth People's Hospital from January to December 2023 were selected as research subjects. The FRAIL, CFS, and REFS scales were used to assess the frailty index. Patient data were collected and a delirium-related risk cohort was constructed. The incidence of delirium, duration of occurrence, and prognostic outcomes were recorded. The FRAIL, CFS, and REFS scale scores between patients with and without delirium were analyzed. Clinical characteristics were compared between the two groups. Logistic regression analysis was used to identify risk factors for delirium in elderly frail patients, and ROC curve analysis was performed to evaluate the predictive efficacy of FRAIL, CFS, and REFS for delirium occurrence in elderly frail patients. Results Among the 187 elderly frail hospitalized patients, 34 cases （18.18%） developed delirium, and 153 cases （81.82%） did not develop delirium. The FRAIL, CFS, and REFS scale scores in the delirium group were significantly higher than in the non-delirium group （P < 0.05）. There were significant differences between the two groups in age, stroke history, malnutrition, cognitive impairment, activity limitation, and severe pain （P < 0.05）. Logistic regression results showed that age ≥75 years, stroke, malnutrition, cognitive impairment, activity limitation, severe pain, FRAIL, CFS, and REFS were all risk factors for delirium in elderly frail patients （P < 0.05）. ROC curve analysis demonstrated that REFS had a higher area under the ROC curve （AUC = 0.813, 95%CI: 0.739-0.843） for predicting delirium in elderly frail patients compared to FRAIL and CFS. Conclusions The main factors affecting delirium occurrence in elderly frail patients are related to age ≥75 years, stroke, malnutrition, cognitive impairment, activity limitation, severe pain, and degree of frailty. The REFS scale demonstrates superior predictive efficacy for delirium compared to the FRAIL and CFS scales.
- Elderly frailty,
- Delirium,
- FRAIL scale,
- CFS,
- REFS,
- Risk factor

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References(23)

References

[1]	曹成霖, 吴新春, 纪凯, 等. 老年衰弱研究进展[J]. 中国临床保健杂志, 2023, 26(2): 274-278. doi: 10.12114/j.issn.1007-9572.2023.0719
[2]	石婧, 石冰, 陶永康, 等. 基于衰弱指数评估的老年人衰弱状况与死亡风险的相关性分析[J]. 中华流行病学杂志, 2020, 41(11): 1824-1830. doi: 10.3760/cma.j.cn112338-20200506-00691
[3]	许丽, 张蒙, 韦靖怡, 等. 预防住院老年病人发生谵妄照护方案实施及效果评价[J]. 实用老年医学, 2023, 37(2): 204-208.
[4]	陈敏, 宋清扬, 王爽, 等. 老年住院患者衰弱指数与谵妄的相关性研究[J]. 国际精神病学杂志, 2022, 49(2): 259-262, 266.
[5]	鲁云竹, 郭松青, 陈鑫, 等. 心脏手术衰弱老年患者术后谵妄的危险因素及其预测模型的建立[J]. 中华麻醉学杂志, 2022(11): 1316-1319.
[6]	秦兰芳, 郭文熙, 王瑞, 等. 骨科住院老年患者衰弱评估工具的范围综述[J]. 中国全科医学, 2023, 26(23): 2864-2870. doi: 10.12114/j.issn.1007-9572.2022.0866
[7]	中华医学会老年医学分会. 老年人运动能力下降多学科决策模式中国专家共识(2024版)[J]. 中华医学杂志, 2024, 104(12): 893-905. doi: 10.3760/cma.j.cn112137-20230816-00238
[8]	中华医学会老年医学分会. 老年患者术后谵妄防治中国专家共识[J]. 中华老年医学杂志, 2016, 35(12): 1257-1262. doi: 10.3760/cma.j.cn321761-20220915-10005
[9]	高浪丽, 冯冬梅, 王荣海, 等. 意识模糊评估法简短量表的汉化及用于老年谵妄的信度和效度研究[J]. 实用老年医学, 2019, 33(2): 133-136.
[10]	Thompson M Q, Theou O, Tucker G R, et al. FRAIL scale: Predictive validity and diagnostic test accuracy[J]. Australas J Ageing, 2020, 39(4): e529-e536.
[11]	Fehlmann C A, Nickel C H, Cino E, et al. Frailty assessment in emergency medicine using the Clinical Frailty Scale: A scoping review[J]. Intern Emerg Med, 2022, 17(8): 2407-2418. doi: 10.1007/s11739-022-03042-5
[12]	Roopsawang I, Thompson H, Zaslavsky O, et al. The reported Edmonton frail scale-Thai version: Development and validation of a culturally-sensitive instrument[J]. Nurs Health Sci, 2020, 22(3): 685-693. doi: 10.1111/nhs.12713
[13]	Hersberger L, Bargetzi L, Bargetzi A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: Secondary analysis of a prospective randomised trial[J]. Clin Nutr, 2020, 39(9): 2720-2729. doi: 10.1016/j.clnu.2019.11.041
[14]	Schönstein A, Wahl H W, Katus H A, et al. SPMSQ for risk stratification of older patients in the emergency department: An exploratory prospective cohort study[J]. Z Gerontol Geriatr, 2019, 52(Suppl 4): 222-228.
[15]	Costantini L, Pasquarella C, Odone A, et al. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review[J]. J Affect Disord, 2021, 279: 473-483. doi: 10.1016/j.jad.2020.09.131
[16]	Toussaint A, Hüsing P, Gumz A, et al. Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7)[J]. J Affect Disord, 2020, 265: 395-401. doi: 10.1016/j.jad.2020.01.032
[17]	Bouwstra H, Smit E B, Wattel E M, et al. Measurement properties of the barthel index in geriatric rehabilitation[J]. J Am Med Dir Assoc, 2019, 20(4): 420-425. e1.
[18]	Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, same or different? are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy?[J]. Pain Res Manag, 2022, 2022: 5337483.
[19]	Okajima I, Miyamoto T, Ubara A, et al. Evaluation of severity levels of the Athens insomnia scale based on the criterion of insomnia severity index[J]. Int J Environ Res Public Health, 2020, 17(23): 8789. doi: 10.3390/ijerph17238789
[20]	陶二存, 刘琴, 杨昌龙, 等. 改良衰弱指数与睡眠质量预测老年患者术后谵妄发生的价值[J]. 国际精神病学杂志, 2024, 51(2): 571-575. doi: 10.13479/j.cnki.jip.2024.02.036
[21]	张真真, 周晓艳, 曹林, 等. 术前衰弱对行膝髋关节置换手术老年患者术后谵妄的影响[J]. 医学研究生学报, 2021, 34(4): 371-374. doi: 10.16571/j.cnki.1008-8199.2021.04.007
[22]	王佳, 孙莹, 王春玲, 等. 骨科老年手术患者老年综合征情况及术后并发症的影响因素分析[J]. 中华全科医师杂志, 2023, 22(10): 1068-1072. doi: 10.3760/cma.j.cn114798-20230726-00707
[23]	杨梦娇, 高梅. 三种衰弱评估方法对老年骨科患者术后谵妄的预测作用[J]. 国际老年医学杂志, 2023, 44(5): 548-555. doi: 10.3969/j.issn.1674-7593.2023.05.007

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