Clinical Frailty Scale as A Predictor of 2-Year Mortality and Associated Risk Factors in Older Diabetic Patients

Frailty assessment in older diabetic patients is crucial for identifying high-risk patients for interventions targeting modifiable risk factors, thus preventing complications and mortality. This study aimed to evaluate the use of the clinical frailty scale (CFS) to predict mortality in community-dwelling older diabetic patients.

We conducted a retrospective cohort study to evaluate the use of CFS in predicting 2-year all-cause mortality and to examine the mortality risk factors. Community-dwelling older diabetic adults at least 65 years old were identified from the registry of hospital-discharged patients enrolled in the discharge support program between 1 August 2018 and 31 December 2019. Patients were excluded if they died during the index admission, had exclusive medical follow-up in the private sector, or were discharged directly to residential care homes.

All-cause mortality within 2 years was 23%. Patients with CFS 5 had a hazard ratio (HR) of 1.70 (p = 0.014), CFS 6 had a HR of 2.30 (p < 0.001), and CFS 7-8 had a HR of 5.11 (p < 0.001) compared to patients with CFS 1-4. Age was not a significant risk factor after adjustment. Poor nutritional status (lower BMI and albumin level), cardiovascular diseases including ischemic heart disease and congestive heart failure, and history of malignancy were associated with a higher risk of mortality.

CFS is a strong predictor of mortality within a short period of 2 years in community-dwelling older diabetic patients. Early identification of frailty allows timely interventions that target mortality risk factors, potentially improving outcomes and reducing mortality in these patients.