Outcomes of hospital admissions among frail older people: a 2-year cohort study

Abstract

Background‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty.AimTo determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status.Design and settingTwo populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays.MethodData for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data.ResultsMortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail.ConclusionIndividuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.

Factors associated with admission to bed-based care: observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)

“…Our findings are in keeping with data from the Emergency Department/medical admissions setting in which patients with frailty were less likely to be discharged immediately or to have short (< 72 h) admissions, and only 23–40% of non-admitted patients were frail [ 13 ]. Although multi-morbidity as defined by the Charlson index was more common as expected in the older patients in our study, associations with admission for bed-based care were relatively weak and did not reach significance after Bonferroni correction, or in multivariable analyses.…”

“…heart failure, pulmonary embolism, syncope) [ 12 ] may not be applicable to older patients in whom multi-morbidity, frailty and non-specific presentations of disease are common. Data from emergency departments/medical units suggest that SDEC is used less frequently in older, frail people [ 13 ]. Small studies suggest SDEC may reduce admissions in carefully selected older patients, although numbers are too small to draw firm conclusions regarding later readmission rates [ 14 , 15 ], and the care model is liked by patients [ 16 ].…”

Time trends in hospital admissions in very elderly patients (≥85 years-old) in Spain: data from the Spanish National Discharge Database (2000 - 2015)

“…Previous studies analyzing trends in hospitalized patients have focused on speci c diseases (9, 10) or single centers, limiting the size of the population analyzed (11,12). To our knowledge, this is the rst study to analyze the general trends in very elderly hospitalized patients in Spain, although the Spanish Ministry of Health does periodically provide a summary of the information contained in the MBDS.…”

Frailty: Tackling the crisis

“…. After a recent hospital admission that appears to be prolonged following a minor illness; in most cases, a CGA would have been started by the geriatrician, but this needs to be reviewed in the context of community care (Keeble et al, 2019) . Most care home residents (both those with and without nursing care) as most will have frailty; the process of CGA will help to identify the future treatment goals and support the necessary advance care planning…”