The Predictive Value of The 9-Point Clinical Frailty Scale on Outcomes in Older Adults with Hip Fracture: A Systematic Review

Abstract

Abstract Hip fracture is a major cause of morbidity, mortality, and functional decline among older adults. Frailty has emerged as an important prognostic factor in this population, and the Clinical Frailty Scale (CFS) offers a rapid and practical method for assessing frailty. This systematic review assessed the prognostic value of the 9-point CFS in older adults with hip fracture. A systematic search of PubMed, Scopus, and Web of Science was conducted for studies published between 2016 and 2025. Eligible studies included adults aged ≥65 years with hip fracture whose frailty was assessed using the CFS. Outcomes included mortality, postoperative complications, delirium, length of hospital stay, readmissions, discharge destination, institutionalization, and functional recovery. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale. Due to heterogeneity in frailty thresholds, outcome definitions, and follow up duration, findings were summarized narratively. Fifteen studies involving more than 18,000 older adults were included. Higher CFS scores were consistently associated with increased short and long term mortality, post-operative complications, delirium, prolonged hospital stay, higher readmission rates, and greater likelihood of institutional discharge. The 9-point Clinical Frailty Scale is a practical prognostic tool in older adults with hip fracture.