Delirium is significantly associated with hospital frailty risk score derived from administrative data

Lim, Zhiying; Ling, Natalie; Ho, Vanda; Vidhya, Nachammai; Chen, Matthew; Wong, Beatrix Ling Ling; Ng, Siew Bee; Murphy, Diarmuid; Merchant, Reshma Aziz

doi:10.1002/gps.5872

Cited by 7 publications

(7 citation statements)

References 52 publications

(108 reference statements)

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“…More recently, a 2023 Japanese study also demonstrated the association of higher HFRS scores with higher rates of prolonged hospitalization (LOS > 15 days and LOS > 30 days) amongst 98 420 patients with pneumonia 33 . A local study of 902 patients admitted to a tertiary hospital also demonstrated that patients with delirium had higher HFRS scores and had greater 30‐day mortality (OR 2.52) and 30‐day readmission (OR 2.18) 21 . Patients with delirium were also shown to have a higher prevalence of infections such as pneumonia (37.7% vs. 25.3%) 21 …”

Section: Discussionmentioning

confidence: 96%

“…33 A local study of 902 patients admitted to a tertiary hospital also demonstrated that patients with delirium had higher HFRS scores and had greater 30-day mortality (OR 2.52) and 30-day readmission (OR 2.18). 21 Patients with delirium were also shown to have a higher prevalence of infections such as pneumonia (37.7% vs. 25.3%). 21 Our study has a number of strengths.…”

Section: Discussionmentioning

confidence: 99%

“…21 Patients with delirium were also shown to have a higher prevalence of infections such as pneumonia (37.7% vs. 25.3%). 21 Our study has a number of strengths. First, we were able to analyse a large group of older patients admitted with CAP, of which a significant proportion (358; 83.4%) were at intermediate or high risk of frailty.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the HFRS has been validated in multiple cohorts of patients in several countries, [17][18][19][20] including Singapore. 21 However, the scope of studies done to date to validate the use of the HFRS in the context of Singapore is still too limited to warrant its implementation.…”

Section: Introductionmentioning

confidence: 99%

“…The HFRS is non‐operator‐dependent 16 and has been validated against the two widely used clinical frailty screening tools, the Fried phenotype and the Rockwood Clinical Frailty Scale, which both require more manpower resources and a face‐to‐face assessment. Currently, the HFRS has been validated in multiple cohorts of patients in several countries, 17–20 including Singapore 21 . However, the scope of studies done to date to validate the use of the HFRS in the context of Singapore is still too limited to warrant its implementation.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the Hospital Frailty Risk Score in older adults hospitalized with community‐acquired pneumonia

Rosario,

Quah,

Chang

et al. 2023

Geriatrics Gerontology Int

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AimFrailty results from age‐associated declines in physiological reserve and function and is prevalent in older people. Our aim is to examine the association of the Hospital Frailty Risk Score (HFRS) with adverse events in older patients hospitalized with community‐acquired pneumonia (CAP) and hypothesise that frailty is a comparable predictor of outcomes in CAP versus traditional severity indices such as CURB‐65.MethodsRetrospective review of electronic medical records in patients ≥65 years with CAP admitted to a tertiary hospital from 1 January to 30 April 2021. Patients were identified using ICD codes for CAP and categorized as high risk (>15), intermediate risk (5–15) and low risk (<5) of frailty using the HFRS.ResultsOf 429 patients with CAP, 53.8% male, mean age of 82.9 years, older patients (85 vs. 79.7 years, P < 0.001) were at higher risk of frailty. Using the HFRS, 47.6% were deemed at high risk, 35.9% at intermediate risk, and 16.6% at low risk of frailty. Multivariate logistic regression shows that HFRS was more strongly associated (≥7 days, OR 1.042, CI 1.017–1.069) than CURB‐65 (OR 0.995, CI 0.810–1.222) with long hospital length of stay (LOS), while CURB‐65 (Confusion, Urea >7mmol/L, Respiratory rate >30, Blood pressure, age => 65 years old) was more strongly associated with mortality at 30, 90 and 365 days, compared with the HFRS. Comparing the values for the area under the receiver operator characteristic curve, the HFRS was found to be a better predictor of long LOS, while CURB‐65 remains a better predictor of mortality.ConclusionsPatients with high risk of frailty have higher healthcare utilization and HFRS is a better predictor of long LOS than CURB‐65 but CURB‐65 was a better predictor of mortality. Geriatr Gerontol Int 2023; ••: ••–••.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of the Hospital Frailty Risk Score in older adults hospitalized with community‐acquired pneumonia

Rosario,

Quah,

Chang

et al. 2023

Geriatrics Gerontology Int

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Delirium is significantly associated with hospital frailty risk score derived from administrative data

Lim

Ling

et al. 2023

Int J Geriat Psychiatry

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Objectives Delirium is highly prevalent in hospitalised older adults, under‐diagnosed and associated with poor outcomes. We aim to determine (i) association of frailty measured using Hospital Frailty Risk Score (HFRS) with delirium, (ii) impact of delirium on mortality, 30‐days readmission, extended length of stay (eLOS) and cost (eCOST). Methods Retrospective cohort study was conducted on 902 older adults ≥75 years discharged from an academic tertiary hospital between March and September 2021. Data was obtained from hospital administrative database. Results Delirium was prevalent in 39.1%, 58.1% were female with mean age 85.3 ± 6.2 years. Patients with delirium were significantly older, had higher HFRS, pneumonia, urinary tract infection (UTI), E.coli and Klebsiella infection, constipation, dehydration, stroke and intracranial bleed, with comorbidities including dementia, diabetes, hypertension, hyperlipidaemia and chronic kidney disease. In‐hospital mortality, 30‐days mortality, 30‐days readmission, median LOS and cost was significantly higher. Delirium was significantly associated with at least intermediate frailty (OR = 3.52; CI = 2.48–4.98), dementia (OR = 2.39; CI = 1.61–3.54), UTI (OR = 1.95; CI = 1.29–2.95), constipation (OR = 2.49; CI = 1.43–4.33), Klebsiella infection (OR = 3.06; CI = 1.28–7.30), dehydration (OR = 2.01; CI = 1.40 ‐ 2.88), 30‐day mortality (OR = 2.52; CI = 1.42–4.47), 30‐day readmission (OR = 2.18; CI = 1.36–3.48), eLOS (OR = 1.80; CI = 1.30–2.49) and eCOST (OR = 1.67; CI = 1.20–2.35). Conclusions Delirium was highly prevalent in older inpatients, and associated with dementia, frailty, increased cost, LOS, 30‐day readmissions and mortality. Hospital Frailty Risk Score had robust association with delirium and can be auto‐populated from electronic medical records. Prospective studies are needed on multicomponent delirium preventive measures in high‐risk groups identified by HFRS in acute care settings.

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The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review

Richardson,

Cropp,

Ellis

et al. 2024

Age and Ageing

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Introduction Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. Methods Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. Results After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. Conclusion Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.

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Delirium is significantly associated with hospital frailty risk score derived from administrative data

Cited by 7 publications

References 52 publications

Validation of the Hospital Frailty Risk Score in older adults hospitalized with community‐acquired pneumonia

Validation of the Hospital Frailty Risk Score in older adults hospitalized with community‐acquired pneumonia

Delirium is significantly associated with hospital frailty risk score derived from administrative data

The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review

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