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Age Ageing. 2014 Jan;43(1):127-32. doi: 10.1093/ageing/aft156. Epub 2013 Oct 30.

The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment.

Author information

1
Catholic Health System, Catholic Health System of Western New York, Buffalo, NY, USA.

Abstract

BACKGROUND:

prognostication for frail older adults is complex, especially when they become seriously ill.

OBJECTIVES:

to test the measurement properties, especially the predictive validity, of a frailty index based on a comprehensive geriatric assessment (FI-CGA) in an acute care setting in relation to the risk of death, length of stay and discharge destination.

DESIGN AND SETTING:

prospective cohort study. Inpatient medical units in a teaching, acute care hospital.

SUBJECTS:

individuals on inpatient medical units in a hospital, n = 752, aged 75+ years, were evaluated on their first hospital day; to test reliability, a subsample (n = 231) was seen again on Day 3.

MEASUREMENTS:

all frailty data collected routinely as part of a CGA were used to create the FI-CGA. Mortality data were reviewed from hospital records, claims data, Social Security Death Index and interviews with Discharge Managers.

RESULTS:

thirty-day mortality was 93 (12.4%; 95% confidence interval (CI) = 10-15%) of whom 52 died in hospital. The risk of dying increased with each 0.01 increment in the FI-CGA: hazard ratio (HR) = 1.05, (95% CI = 1.04-1.07). People who were discharged home had the lowest admitting mean FI-CGA = 0.38 (┬▒standard deviation 0.11) compared with those who died, FI-CGA = 0.51 (┬▒0.12) or were discharged to nursing home, FI-CGA = 0.49 (┬▒0.11). Likewise, increasing FI-CGA values on admission were significantly associated with a longer length of hospital stay.

CONCLUSIONS:

frailty, measured by the FI-CGA, was independently associated with a higher risk of death and other adverse outcomes in older people admitted to an acute care hospital.

KEYWORDS:

acute care; age; frailty index based on a comprehensive geriatric assessment; mortality; older people; prognosis

PMID:
24171946
DOI:
10.1093/ageing/aft156
[Indexed for MEDLINE]

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