Frailty status at admission to hospital predicts multiple adverse outcomes

TitleFrailty status at admission to hospital predicts multiple adverse outcomes
Publication TypeJournal Article
Year of Publication2017
AuthorsHubbard R.E, Peel N.M, Samanta M., Gray L.C, Mitnitski A., Rockwood K.
JournalAge Ageing
Volume46
Issue5
Pagination801-806
Date PublishedSep 1
ISBN Number0002-0729
Accession Number28531254
Keywords*Frail Elderly, *Patient Admission, Accidental Falls, Age Factors, Aged, aging, Area Under Curve, Australia/epidemiology, delirium, Delirium/epidemiology, Electronic Health Records, Female, frail older people, Frailty/*diagnosis/mortality/therapy, Geriatric Assessment/*methods, Hospital Mortality, Humans, Incidence, Inpatients, length of stay, Logistic Models, Male, Odds Ratio, Patient Discharge, Predictive Value of Tests, Pressure Ulcer/epidemiology, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, ROC Curve
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

URLhttps://www.ncbi.nlm.nih.gov/pubmed/28531254
DOI10.1093/ageing/afx081
Alternate JournalAge and ageing