Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study

Abstract

BackgroundLowering mortality and hospitalization of older adults is one of the main goals of public health to improve both health systems’ sustainability and older adults’ quality of life. The aim of this study is to identify the determinants associated with mortality and the use of hospital services in the population older than 64 years of age.MethodsA randomized sample from the population of the Lazio region (Italy) above the age of 64 was enrolled in 2014 by the administration of a questionnaire to assess frailty; the rates of use of hospital services and mortality in the year following the enrolment have been retrieved by the regional database. Univariable and multivariable analyses addressed the association of health status, social and economic variables with health outcomes.ResultsOne thousand two hundred and eighty persons were recruited; 52 deaths were reported at 1 year of follow-up (robust 1.8%, frail 10.1% and very frail 19.1%, P < 0.001). The mean rate of use of hospital services was 692.2 per 1000 observation/year (robust 589.5, frail 1191.1 and very frail 848.4, P < 0.001). In the multivariate analysis, the higher rate of use of hospital services was independently associated with functional status, social support, psychological/psychiatric discomfort, availability of home care services and physical health.ConclusionsFrailty, as a multidimensional issue, is also a strong predictor of survival in the short term. The use of the hospital services by older adults is associated mainly with functional status, social resources, psycho-physical status and health service organization factors.

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

“…Moreover, this result is consistent with another study conducted with a similar population in which the use of hospital care was associated with compromised socio-economic resources, functional status and community care more than with diseases (Gilardi et al, 2018).…”

Advance care plans and hospitalized frail older adults: a systematic review

“…Frailty is associated with major adverse health outcomes, including falls, delirium, and death, as well as greater use of hospital services 1 2. In the USA, patients with frailty are more than twice as likely to die in the intensive care unit than patients with cancer and the families of frail patients are less likely to rate their end-of-life care as excellent 3.…”

“…There has been no systematic review of frail older people in the hospital inpatient setting, who may be regarded as a particularly ‘in need’ group, given their increased risk of morbidity and mortality 17. Moreover, admission to an acute hospital may be seen as a potential opportunity for ACP given the higher use of hospital services by frail patients 2…”

Social Interventions to Prevent Heat-Related Mortality in the Older Adult in Rome, Italy: A Quasi-Experimental Study

“…Heat-related mortality is a growing public health concern worldwide because of the increased number of older adults highly susceptible to the effects of heat. In fact, heat-related mortality amongst those over 75 is becoming a major issue because of the high prevalence of frail individuals, who show a higher risk of death as a consequence of psycho-physical impairment and/or lack of socio-economic resources [ 1 , 2 , 3 ]. In this context, the heat waves that hit Southern Europe during the summers of 2003 and 2015 were the most relevant episodes in causing an increase of deaths in older adults [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”