Development and pilot implementation of a digitally integrated frailty-triggered comprehensive geriatric assessment system for older inpatients.

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.