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Age Ageing. 2017 Sep 1;46(5):801-806. doi: 10.1093/ageing/afx081.

Frailty status at admission to hospital predicts multiple adverse outcomes.

Author information

1
Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
2
Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
3
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

Aims:

frailty is proposed as a summative measure of health status and marker of individual vulnerability. We aimed to investigate the discriminative capacity of a frailty index (FI) derived from interRAI Comprehensive Geriatric Assessment for Acute Care (AC) in relation to multiple adverse inpatient outcomes.

Methods:

in this prospective cohort study, an FI was derived for 1,418 patients ≥70 years across 11 hospitals in Australia. The interRAI-AC was administered at admission and discharge by trained nurses, who also screened patients daily for geriatric syndromes.

Results:

in adjusted logistic regression models an increase of 0.1 in FI was significantly associated with increased likelihood of length of stay >28 days (odds ratio [OR]: 1.29 [1.10-1.52]), new discharge to residential aged care (OR: 1.31 [1.10-1.57]), in-hospital falls (OR: 1.29 [1.10-1.50]), delirium (OR: 2.34 [2.08-2.63]), pressure ulcer incidence (OR: 1.51 [1.23-1.87]) and inpatient mortality (OR: 2.01 [1.66-2.42]). For each of these adverse outcomes, the cut-point at which optimal sensitivity and specificity occurred was for an FI > 0.40. Specificity was higher than sensitivity with positive predictive values of 7-52% and negative predictive values of 88-98%. FI-AC was not significantly associated with readmissions to hospital.

Conclusions:

the interRAI-AC can be used to derive a single score that predicts multiple adverse outcomes in older inpatients. A score of ≤0.40 can well discriminate patients who are unlikely to die or experience a geriatric syndrome. Whether the FI-AC can result in management decisions that improve outcomes requires further study.

KEYWORDS:

delirium; electronic health records; frail older people; inpatients

PMID:
28531254
DOI:
10.1093/ageing/afx081
[Indexed for MEDLINE]

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