Frailty status at admission to hospital predicts multiple adverse outcomes

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

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.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Accidental Falls
  • Age Factors
  • Aged
  • Aging
  • Area Under Curve
  • Australia / epidemiology
  • Delirium / epidemiology
  • Electronic Health Records
  • Female
  • Frail Elderly*
  • Frailty / diagnosis*
  • Frailty / mortality
  • Frailty / therapy
  • Geriatric Assessment / methods*
  • Hospital Mortality
  • Humans
  • Incidence
  • Length of Stay
  • Logistic Models
  • Male
  • Odds Ratio
  • Patient Admission*
  • Patient Discharge
  • Predictive Value of Tests
  • Pressure Ulcer / epidemiology
  • Prospective Studies
  • ROC Curve
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors