Association between frailty and 30-day outcomes after discharge from hospital

Background: Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards. Methods: We prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge. Results: Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12–4.24). Interpretation: Frailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards.

[1]  Christianna S. Williams,et al.  The combined effects of baseline vulnerability and acute hospital events on the development of functional dependence among community-living older persons. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  Jeffrey L. Schnipper,et al.  Inability of Providers to Predict Unplanned Readmissions , 2011, Journal of General Internal Medicine.

[3]  C. Shanley,et al.  Frailty in an Older Inpatient Population , 2015, Journal of aging and health.

[4]  Andrew D Auerbach,et al.  Functional impairment and hospital readmission in Medicare seniors. , 2015, JAMA internal medicine.

[5]  Cynthia Brown,et al.  Trajectories of Life-Space Mobility After Hospitalization , 2009, Annals of Internal Medicine.

[6]  S. Iliffe,et al.  Frailty in elderly people , 2013, The Lancet.

[7]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  L. Ferrucci,et al.  Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[9]  D. Rolfson,et al.  The assessment of frailty in older people in acute care , 2009, Australasian journal on ageing.

[10]  D. Segev,et al.  Frailty and Early Hospital Readmission After Kidney Transplantation , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[11]  H. Boter,et al.  Prevalence of Frailty in Community‐Dwelling Older Persons: A Systematic Review , 2012, Journal of the American Geriatrics Society.

[12]  Shwu-chong Wu,et al.  Unplanned hospital readmission and its predictors in patients with chronic conditions. , 2002, Journal of the Formosan Medical Association = Taiwan yi zhi.

[13]  J. Edmans,et al.  The predictive properties of frailty-rating scales in the acute medical unit , 2013, Age and ageing.

[14]  Theodore R Holford,et al.  Hospitalization, restricted activity, and the development of disability among older persons. , 2004, JAMA.

[15]  I. McDowell,et al.  A global clinical measure of fitness and frailty in elderly people , 2005, Canadian Medical Association Journal.

[16]  M. Makary,et al.  Frailty as a predictor of surgical outcomes in older patients. , 2010, Journal of the American College of Surgeons.

[17]  P. Austin,et al.  Proportion of hospital readmissions deemed avoidable: a systematic review , 2011, Canadian Medical Association Journal.

[18]  Leora I. Horwitz,et al.  Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. , 2013, JAMA.

[19]  Kenneth Rockwood,et al.  Accumulation of Deficits as a Proxy Measure of Aging , 2001, TheScientificWorldJournal.

[20]  Richard H Fortinsky,et al.  Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness , 2008, Journal of the American Geriatrics Society.

[21]  P. Austin,et al.  Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community , 2010, Canadian Medical Association Journal.

[22]  Kenneth Rockwood,et al.  Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation , 2010, Journal of the American Geriatrics Society.

[23]  V. K. Bhalla,et al.  Predicting readmissions: poor performance of the LACE index in an older UK population. , 2012, Age and ageing.

[24]  S. Bagshaw,et al.  Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study , 2014, Canadian Medical Association Journal.

[25]  Koen Milisen,et al.  Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients , 2014, BMC Geriatrics.

[26]  Harlan M Krumholz,et al.  Post-hospital syndrome--an acquired, transient condition of generalized risk. , 2013, The New England journal of medicine.

[27]  J. Tepas.  Simple frailty score predicts postoperative complications across surgical specialties. , 2013, American journal of surgery.

[28]  E. Pfeiffer.  A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients † , 1975, Journal of the American Geriatrics Society.

[29]  Konstantin G Arbeev,et al.  Cumulative Deficits Better Characterize Susceptibility to Death in Elderly People than Phenotypic Frailty: Lessons from the Cardiovascular Health Study , 2008, Journal of the American Geriatrics Society.

[30]  Amanda H. Salanitro,et al.  Risk prediction models for hospital readmission: a systematic review. , 2011, JAMA.