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Development and pilot implementation of a digitally integrated frailty-triggered comprehensive geriatric assessment
Yi-Chun Chou1, Shey-Ying Chen2, Yu-Tzu Li3
1Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 100229, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, 100233, Taiwan.
Background:
Frailty is prevalent among hospitalized older adults and associated with adverse outcomes, yet it is rarely assessed systematically in acute care. Comprehensive geriatric assessment (CGA), a key component of frailty care, remains underutilized. System-level integration of frailty identification with structured CGA may facilitate its implementation in routine care.
Methods:
We developed a digitally integrated frailty-triggered CGA system incorporating three steps: frailty identification using the Clinical Frailty Scale (CFS), stratified care pathways by CFS levels, and FINDNEEDS-based CGA for CFS 4-7. This retrospective observational study evaluated its pilot implementation in inpatient wards at a medical center between March and November 2025. Outcomes focused on process and implementation measures, including time to CFS assessment, frailty distribution, and management actions. In a subset with available clinician-led CGA, FINDNEEDS was compared with clinician-led CGA using Cohen's kappa for domain-level agreement and Spearman's correlation for the total number of abnormal domains.
Results:
CFS assessment was completed within 4 days in 71% of patients. Hospital outcomes varied across frailty levels, with longer length of stay and higher in-hospital mortality among more frail patients. Among those with CFS 4-7, the number of geriatric problems increased with frailty levels. FINDNEEDS showed varied agreement with clinician-led CGA across geriatric domains, with a modest correlation for total abnormal domains (ρ = 0.38, p < 0.001).
Conclusions:
This system demonstrates the feasibility of systematic frailty identification and structured geriatric assessment in selected inpatient wards. Its impact on patient outcomes should be evaluated in future controlled studies.