Design and rationale of the Western Sydney Clinical Frailty Registry: A prospective observational long-term clinical cohort study

  • Caleb Ferguson
    Corresponding author at: School of Nursing, University of Wollongong, Blacktown Hospital, Marcel Crescent, Blacktown, NSW 2148, Australia.
    School of Nursing, University of Wollongong, NSW Australia

    Western Sydney Local Health District, NSW, Australia
    Search for articles by this author
  • Lien Lombardo
    School of Nursing & Midwifery, Western Sydney University, NSW Australia

    Nepean Blue Mountains Local Health District, NSW, Australia
    Search for articles by this author
  • Jai Mehta
    Western Sydney Local Health District, NSW, Australia

    Nepean Blue Mountains Local Health District, NSW, Australia
    Search for articles by this author
  • Richard I Lindley
    Faculty of Medicine, Westmead Clinical School, University of Sydney, NSW, Australia

    The George Institute, Camperdown, NSW, Australia

    Blacktown & Mount Druitt Hospital, Blacktown, NSW, Australia
    Search for articles by this author
Published:October 03, 2022DOI:



      Frail older adults are frequently admitted to hospital with complex care needs, however little is known about their clinical profile, inpatient management or outcomes.


      (i) To establish a baseline clinical profile of patients with frailty; (ii) To obtain a representative cross-sectional view of patients with frailty and their acute inpatient clinical management; (iii) To determine the rate and clinical outcomes of frailty among hospitalised patients.


      The study will be conducted in a Western Sydney tertiary teaching hospital (Blacktown and Mount Druitt Hospital), serving a large socio-economically diverse, multi-cultural community. A long-term, prospective observational clinical cohort of patients who are admitted under Rehabilitation and Aged Care Services over the next 5-year period (2020–25) will be conducted. Frailty will be assessed using the Clinical Frailty Scale, and the FI-ED frailty instrument, performance will be assessed using the Australian-modified Karnofsky Performance Status (AKPS). Participants will be followed-up at 3, 6, and 12 months by telephone, following their index hospitalisation. Outcomes of interest include all-cause rehospitalisation (including emergency department presentation), mortality and admission to residential aged care service over the period of 12 months. Data Linkage endpoint assessment will be undertaken at 1, 2, and 5 years.


      Frailty is an emergent area of clinical and research interest. It is an important prognostic indicator of mortality, rehospitalisation and institutionalisation.


      This study will provide longitudinal data to demonstrate short, mid, or long-term outcomes of hospitalised frail older adults. Data will be used to inform future studies and quality improvement activities.


      It is envisioned that the registry will act as a spine project for future multi-disciplinary research opportunities including interventional studies, data linkage studies and quality improvement projects, thus enabling robust medium – long term examination of outcomes of interest, such as mortality, rehospitalisation and admission to residential aged care within this area of growing concern. There are plans to engage more disciplines in the registry's research capacity-building endeavours and we have identified the need for greater consumer engagement and public involvement. The sustainability of the registry needs to be considered within the context of ongoing research funding and making better use of these data for continuous quality improvement.

      Registry registration

      The registry was registered with the Australian Register of Clinical Registries (Australian Commission on Safety and Quality in Healthcare) on 3rd August 2020.(

      Australian Commission on Safety and Quality in Healthcare. (2020). Australian Register of Clinical Registries. Retrieved 08/09/2020 from

      ) Reference ACSQHC-ARCR-095. Available via


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abernethy A.P.
        • Shelby-James T.
        • Fazekas B.S.
        • Woods D.
        • Currow D.C.
        The Australia-modified Karnofsky Performance Status (AKPS) scale: A revised scale for contemporary palliative care clinical practice [ISRCTN81117481].
        BMC Palliative Care. 2005; 4: 7
      1. Australian Commission on Safety and Quality in Healthcare. (2020). Australian Register of Clinical Registries. Retrieved 08/09/2020 from

        • Brousseau A.-A.
        • Dent E.
        • Hubbard R.
        • Melady D.
        • Émond M.
        • Mercier É.
        • et al.
        Identification of older adults with frailty in the Emergency Department using a frailty index: Results from a multinational study.
        Age and Ageing. 2018; 47: 242-248
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • Gold J.
        Validation of a combined comorbidity index.
        Journal of Clinical Epidemiology. 1994; 47: 1245-1251
        • Collard R.M.
        • Boter H.
        • Schoevers R.A.
        • Oude Voshaar R.C.
        Prevalence of frailty in community-dwelling older persons: A systematic review.
        Journal of American Geriatric Society. 2012; 60: 1487-1492
      2. Costa, A. P., Hirdes, J. P., & Arino-Blasco, S. Berg K., Boscart V. M., Carpenter C. R., et al. (2017). Inter RAI Emergency Department (ED) Assessment System Manual: For use with the interRAI ED Screener (EDS) and ED Contact Assessment (ED-CA), (Standard English Edition), 9.3.0.

        • Dent E.
        • Martin F.C.
        • Bergman H.
        • Woo J.
        • Romero-Ortuno R.
        • Walston J.D.
        Management of frailty: Opportunities, challenges, and future directions.
        The Lancet. 2019; 394: 1376-1386
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        Journal of Biomedical Informatics. 2009; 42: 377-381
        • Lindley R.I.
        • Waite L.
        • Cullen J.
        Dementia treatment: the need for a paradigm shift.
        Australasian Journal on Ageing. 2019; 38: 149-150
      3. NHMRC, 2018. National Statement on Ethical Conduct in Human Research 2007 (Updated 2018). The National Health and Medical Research Council, the Australian Research Council and Universities Australia. Commonwealth of Australia, Canberra. Available via, Accessed 24th Sept 2022.

        • Rockwood K.
        • Song X.
        • MacKnight C.
        • Bergman H.
        • Hogan D.B.
        • McDowell I.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        Canadian Medical Association Journal. 2005; 173: 489