Identifying frailty earlier to improve outcomes for older people in hospital

National Centre for Healthy Ageing (NCHA) research is creating an innovative tool for identifying frailty in older hospitalised people, to improve outcomes and support early assessment for preventative care.

Frailty, a clinical syndrome, increases vulnerability among older people to adverse health outcomes such as falls, hospitalisation, disability, and mortality. Hospitalised patients who are frail are more likely to experience complications such as prolonged hospital stays, readmissions, or adverse outcomes like delirium and functional decline.

To help address this, a national multi-centre project to develop the Electronic Frailty Index (eFI) – that uses routinely collected data from hospital Electronic Health Records (EHR) – is offering a promising solution. This project is funded by the Medical Research Future Fund awarded to the University of Sydney (Prof Sarah Hilmer), Monash University (Prof Velandai Srikanth) and the University of Queensland (Prof Ruth Hubbard).

The NCHA leads the Victorian arm of the study, to adapt, develop, and validate the eFI by using data from the National Centre for Healthy Ageing Data Platform, which includes hospital EHRs alongside other linked health datasets. The team is analysing de-identified clinical and administrative data from more than 200,000 hospitalised adults aged 60 years and over who attended Peninsula Health between 2015 and 2024. Peninsula Health is a Foundation Partner with Monash University of the National Centre for Healthy Ageing.

NCHA Director, Professor Velandai Srikanth said once developed, the eFI will be specifically tailored for hospital use, ensuring a practical tool for routine frailty assessment in older inpatients.

“The eFI will provide evidence-based stratification of patients based on their frailty status, allowing for targeted interventions and improved management strategies to reduce adverse health outcomes such as readmissions, complications, and mortality,” Professor Srikanth said.

“This tool is intended to be embedded within clinical workflows to support real-time decision-making and resource allocation in hospital settings.”

NCHA and Monash University epidemiologist and data analyst, Dr Asmare Gelaw, said the team will follow 10 key steps to develop the eFI.

“These steps will help carefully select and refine the variables and health measures associated with frailty to ensure the index is both accurate and meaningful,” Dr Gelaw said.

“Additionally, unique to the NCHA, we are using natural language processing – a branch of artificial intelligence for automated analysis of narrative or unstructured text – to extract valuable information from unstructured data sources such as progress notes, discharge summaries, nursing notes, and allied health documentation.”

Australia is ageing, with more than 6.2 million people aged 60 or over in 2024 according to the Australian Bureau of Statistics.

Image: Exercise group at Healthy Futures Hub, Seaford (Peninsula Health Research Report 2025)

Peninsula Health Consultant Geriatrician Dr Jessica Manzoni said frailty is becoming an increasingly significant issue in healthcare and hospital settings.

“Frailty reduces a person’s ability to cope with illness or stress, and even minor injuries or illnesses can escalate when frailty is present, particularly in hospital settings,” Dr Manzoni said.

“We’re also seeing a rise in chronic disease, which compounds these challenges. Frail individuals are less able to manage daily activities, often leading to a reduced quality of life.”

From a hospital perspective, frailty contributes to longer stays, increased risk of complications, and greater reliance on institutional care.

“However, if we can identify frailty early, potentially through tools like the eFI, we can implement targeted strategies to mitigate risks, improve management, and enhance overall outcomes,” Dr Manzoni added.

“This research lays the groundwork for a better understanding of frailty in hospitals and highlights the importance of early assessment to support preventative care.”

Find out more about NCHA’s Living Lab Research Program.

The full article was published in the Peninsula Health Research Report 2025.