Dr Sharma is a Senior Consultant Physician at Flinders Medical Centre, Adelaide and Senior Lecturer in College of Medicine & Public Health, Flinders University. He holds a PhD from Flinders University and his research interests include malnutrition, frailty, clinical epidemiology and Health economics.
Frailty in Acutely Hospitalised Older Patients Admitted
to a Tertiary Hospital
Frailty is a geriatric syndrome characterised by reduced homeostatic reserves that increase patients’ susceptibility to stressors.(Roberts et al.,2018) Frailty screening is not routinely performed in hospitalised patients. The aims of this study were to determine the prevalence of frailty in acutely hospitalised older patients and whether admission frailty status predicts length of stay (LOS), 30-day readmissions and mortality.
Patients referred for an acute General Medical (GM) admission over a period of 2 months were recruited after a written informed consent. Frailty status was assessed using the Edmonton Frailty Scale (EFS)(Perna et al., 2017) and health-related-quality of life (HRQoL) was determined by European Quality-of-Life questionnaire (EQ5D).(Cheung et al., 2009). Outcomes determined included LOS, 30-day unplanned readmissions and mortality. Patients were classified as non-frail if EFS score was ≤7 and frail if EFS ≥8. Multiple regression, adjusted for age and Charlson index (CCI), was used to determine whether frailty status at admission predicts LOS and readmissions. A Kaplan-Meier survival curve was plotted and log-rank test was used to determine survival difference between frail and non-frail patients
Of 552 patients ≥75 years referred for a GM admission, 130 patients selected at random, were approached for participation and valid consent was available for 85 patients. Sixty-seven (78.2%) patients were found to be frail. Frail patients were significantly older and had a higher CCI and lower HRQoL as compared to non-frail patients. Frail patients had a significantly longer LOS (median (iqr) 5.3 (6.7) days vs 2.2 (2.3) days, p<0.008), higher 30-day readmissions and mortality as compared to non-frail patients, even after adjustment for age and CCI.
Frailty is highly prevalent in older general medical patients and rates match those seen in specialised geriatric rehabilitation facilities.(Dent and Hoogendijk, 2014) Considering the poorer health outcomes for these patients, additional allied health input for GM (matching geriatric units) is required.
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