Development of an electronic frailty index for hospitalized older adults in Sweden

Jonathan K L Mak, Sara Hägg, Maria Eriksdotter, Martin Annetorp, Ralf Kuja-Halkola, Laura Kananen, Anne-Marie Boström, Miia Kivipelto, Carina Metzner, Viktoria Bäck Jerlardtz, Malin Engström, Peter Johnson, Lars Göran Lundberg, Elisabet Åkesson, Carina Sühl Öberg, Maria Olsson, Tommy Cederholm, Juulia Jylhävä, Dorota Religa

Research output: Contribution to journalArticleScientificpeer-review


BACKGROUND: Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults.

METHODS: EHRs were extracted for 18,225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from nine geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modelled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression.

RESULTS: 13,188 patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission.

CONCLUSIONS: An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.

Original languageEnglish
JournalJ Gerontol A Biol Sci Med Sci.
Publication statusE-pub ahead of print - 18 Mar 2022
Publication typeA1 Journal article-refereed


Dive into the research topics of 'Development of an electronic frailty index for hospitalized older adults in Sweden'. Together they form a unique fingerprint.

Cite this