Transitions between degrees of multidimensional frailty among older people admitted to intermediate care: a multicentre prospective study

Abstract

Background Frailty is a dynamic condition that is clinically expected to change in older individuals during and around admission to an intermediate care (IC) facility. We aimed to characterize transitions between degrees of frailty before, during, and after admission to IC and assess the impact of these transitions on health outcomes. Methods Multicentre observational prospective study in IC facilities in Catalonia (North-east Spain). The analysis included all individuals aged ≥ 75 years (or younger with chronic complex or advanced diseases) admitted to an IC facility. The primary outcome was frailty, measured by the Frail-VIG index and categorized into four degrees: no frailty, and mild, moderate, and advanced frailty. The Frail-VIG index was measured at baseline (i.e., 30 days before IC admission) (Frail-VIG0), on IC admission (Frail-VIG1), at discharge (Frail-VIG2), and 30 days post-discharge (Frail-VIG3). Results The study included 483 patients with a mean (SD) age of 81.3 (10.2) years. At the time of admission, 27 (5.6%) had no frailty, and 116 (24%), 161 (33.3%), and 179 (37.1%) mild, moderate, and severe frailty, respectively. Most frailty transitions occurred within the 30 days following admission to IC, particularly among patients with moderate frailty on admission. Most patients maintained their frailty status after discharge. Overall, 135 (28%) patients died during IC stay. Frailty, measured either at baseline or admission, was significantly associated with mortality, although it showed a stronger contribution when measured on admission (HR 1.16; 95%CI 1.10–1.22; p < 0.001) compared to baseline (HR 1.10; 1.05–1.15; p < 0.001). When including frailty measurements at the two time points (i.e., baseline and IC admission) in a multivariate model, frailty measured on IC admission but not at baseline significantly contributed to explaining mortality during IC stay. Conclusions Frailty status varied before and during admission to IC. Of the serial frailty measures we collected, frailty on IC admission was the strongest predictor of mortality. Results from this observational study suggest that routine frailty measurement on IC admission could aid clinical management decisions.

Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older

“…The dynamic condition of frailty, or acquired frailty, observed in our ED patients and its impact on short-and long-term adverse outcomes have also been described in patients admitted to acute care and intermediate care hospitals [43,44]. The transition between different frailty states may be modifiable and may improve prognosis [43].…”

Utility of VIG-Frail Index in a ED Short-Stay Unit: Frailty and Mortality Correlation

“…Systematically measuring frailty is undoubtfully useful in patient management, [28] and in the SSU, FI-VIG turned out to be an accurate tool that should be incorporated in clinical practice. FI-VIG assigns to each patient a numerical score, allowing its categorization into different frailty degrees, which, in turn, correlate well with mortality.…”

Utility of VIG-Frail Index in a ED Short-Stay Unit: Frailty and Mortality Correlation

“…Systematically measuring frailty is undoubtfully useful in patient management 28 and in SSU, FI-VIG turned out to be an accurate tool, that should be incorporated in clinical practice. FI-VIG assigns to each patient a numerical score, allowing its categorization in different frailty degrees, which in turn correlate well with mortality.…”

“…The scale has subsequently been validated in the context of intermediate care or health care hospitals 28,29 as well as in the community setting, with the same results. The authors keep it available in different languages and free of charge at https://www.c3rg.com/index-fragil-vig.…”