Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients

IntroductionWith the onset of frailty, there is often a rapid, progressive, and self-perpetuating downward spiral towards death. Frailty has enormous impact on acute hospital care and has been shown to be a more effective predictor of mortality than conventional clinical measures.MethodsHospitalized older patients admitted in medical wards at a teaching public hospital were studied to determine the prevalence of frailty; its association with anemia, congestive heart failure, clinically active tuberculosis and cognitive impairment; as well as its impact upon short-term outcome.ResultsA total of 250 older hospitalized patients were included, and their frailty status was assessed using Fried’s criteria. Of these, 83 (33.2%) patients were frail, with frailty found to be significantly associated with increasing age. A lower mean level of haemoglobin (p, 0.002), higher chance of congestive heart failure (p, <0.001), lower mean MMSE score (p, <0.001), was found in frail older patients. Frail subjects had a higher median hospital stay. There were total of 5 deaths, all among the frail group.ConclusionOur study showed that almost a third of hospitalized older patients are frail, and have anemia, higher frequency of CHF, cognitive impairment, longer hospital stay and higher mortality.

[1]  Harleah G. Buck,et al.  The Impact of Frailty on Health Related Quality of Life in Heart Failure , 2011, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[2]  Nutritional anaemias. Report of a WHO scientific group. , 1968, World Health Organization technical report series.

[3]  W. Hazzard,et al.  Principles of Geriatric Medicine and Gerontology , 2003 .

[4]  Janet M. Corrigan,et al.  Priority Areas for National Action , 2003 .

[5]  Kathleen Koenig,et al.  Serum Interleukin‐6 and Hemoglobin as Physiological Correlates in the Geriatric Syndrome of Frailty: A Pilot Study , 2002, Journal of the American Geriatrics Society.

[6]  P. Abete,et al.  Frailty predicts long‐term mortality in elderly subjects with chronic heart failure , 2005, European journal of clinical investigation.

[7]  C. Cassel Geriatric medicine : an evidence-based approach , 2003 .

[8]  Jean-François Dartigues,et al.  Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three‐City Study , 2009, Journal of the American Geriatrics Society.

[9]  C. Roy Anemia in frailty. , 2011, Clinics in geriatric medicine.

[10]  M. Espallargues,et al.  A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project. , 2005, Age and ageing.

[11]  C. Whelan,et al.  Acute hospital care for the elderly patient: its impact on clinical and hospital systems of care. , 2008, The Medical clinics of North America.

[12]  M. Folstein,et al.  Population-based norms for the Mini-Mental State Examination by age and educational level. , 1993, JAMA.

[13]  G. Frisoni,et al.  Frailty is a strong modulator of heart failure-associated mortality. , 2003, Archives of internal medicine.

[14]  A. Dey,et al.  Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme. , 2001, The National medical journal of India.

[15]  Bruno Vellas,et al.  The assessment of frailty in older adults. , 2010, Clinics in geriatric medicine.

[16]  D. Robertson,et al.  Skeletal Deformities in the Elderly and Their Effect on Postural Sway , 1982, Journal of the American Geriatrics Society.

[17]  R. Fortinsky,et al.  Do Acute Care for Elders Units Increase Hospital Costs? A Cost Analysis Using the Hospital Perspective , 1997, Journal of the American Geriatrics Society.

[18]  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.

[19]  K. Alexander,et al.  Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease , 2006, Journal of the American Geriatrics Society.

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

[21]  W. Kannel,et al.  The natural history of congestive heart failure: the Framingham study. , 1971, The New England journal of medicine.

[22]  Siegwart Lindenberg,et al.  Old or frail: what tells us more? , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[24]  P. Lips,et al.  Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. , 2005, Journal of clinical epidemiology.

[25]  A S Leon,et al.  A questionnaire for the assessment of leisure time physical activities. , 1978, Journal of chronic diseases.

[26]  S. Parker,et al.  Acute hospital care for frail older people. , 2006, Age and ageing.

[27]  J. Cox,et al.  Relative Fitness and Frailty of Elderly Men and Women in Developed Countries and Their Relationship with Mortality , 2005, Journal of the American Geriatrics Society.

[28]  Arnold B Mitnitski,et al.  The mortality rate as a function of accumulated deficits in a frailty index , 2002, Mechanisms of Ageing and Development.

[29]  Douglas K. Miller,et al.  Editorial: Something about frailty. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

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

[31]  G. Pulignano,et al.  Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study , 2010, Journal of cardiovascular medicine.