Preconception and early-pregnancy exposure to ambient air pollution and trajectories of depressive symptoms during pregnancy.

Globally, ageing populations are transforming healthcare systems, placing increasing pressure on hospitals to manage complex age-related conditions and geriatric syndromes. Among these conditions, frailty has emerged as a critical challenge []. Frailty is a multidimensional syndrome characterized by progressive declines in physiological reserve and function, resulting in heightened vulnerability to stressors such as illness, injury, or hospitalisation [, ]. In Singapore acute hospitals, frailty affects an estimated 63–81% of older inpatients [, ], and is associated with adverse outcomes including prolonged hospitalisation, inpatient mortality, and loss of independence after discharge [, , ]. These risks have prompted growing interest in frailty pathways: multidisciplinary, evidence-based care processes embedded within hospital workflows to identify, assess, and manage frailty in older adults []. Promising evidence supports these pathways: their implementation has been associated with reduced length of stay, lower 30-day readmission rates, less functional decline, and improved one-year survival and likelihood of discharges to home [–]. These successes have catalysed international efforts to integrate frailty pathways into routine hospital care [, ]. However, evidence also show that implementing frailty pathways is complex, and successful integration depended on understanding local health system structures and resource availability [, ]. In Singapore, this work is especially timely as the nation approaches “super-aged” status [], and older adults already account for 43% of acute hospital admissions [, ]. National healthcare strategies such as the Action Plan for Successful Ageing and Healthier SG have emphasised improving frailty care in hospitals [, ]. Nevertheless, translating frailty management from policy to practice in the acute setting remains challenging. Prior evidence highlights conceptual ambiguity around frailty definitions, a lack of standardised screening tools, and uneven buy-in across clinical departments as hindrances to implementation [, ]. Time constraints, limited access to geriatric-trained professionals, and resource limitations pose further challenges [, ]. Locally, Changi General Hospital (CGH) is a 1,000-bed tertiary hospital serving over one million residents in eastern Singapore, and provides a full range of acute inpatient, specialist outpatient, and geriatric services. The campus consisted of a Medical Centre for specialist outpatient services, a Main Building (MB) for acute inpatient care wards, and an Integrated Building (IB) to support acute geriatric and rehabilitative care. Although a unified CGH-wide frailty pathway has not yet been established, multiple frailty-related initiatives are in place. The Clinical Frailty Scale (CFS) [] is used in the Emergency Department (ED) to identify older adults for frailty interventions, while the IB employs both the CFS and the modified Hospital Frailty Risk Score (mHFRS) []. Frailty screening and interventions are also embedded within disease- or service-specific workflows such as the Heart Failure Pathway, Geriatric Surgical Services, and Orthogeriatric Services. An internal multidisciplinary frailty group coordinates frailty education, research, and has developed a frailty flow sheet to facilitate care planning. However, current implementation remains fragmented, with challenges in integrating data flow between the ED and inpatient systems and in extending frailty workflows beyond geriatric specialties.