Frailty status at admission to hospital predicts multiple adverse outcomes.
Age Ageing
; 46(5): 801-806, 2017 09 01.
Article
in En
| MEDLINE
| ID: mdl-28531254
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Admission
/
Geriatric Assessment
/
Frail Elderly
/
Frailty
Type of study:
Clinical_trials
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
Oceania
Language:
En
Journal:
Age Ageing
Year:
2017
Document type:
Article
Affiliation country:
Australia