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BackgroundIncreasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians. The objective of this study is to determine whether the clinical frailty scale (CFS) can be used to identify patient baseline frailty status in the acute general medical setting when used by junior medical staff using information obtained on routine clinical assessment.MethodsThis was a prospective cohort study in an acute general medical unit. All patients aged 65 and over admitted to a general medical unit during August and September 2013 were eligible for the study. CFS score at baseline was documented by a member of the treating medical team. Demographic information and outcomes were obtained from medical records. The primary outcomes were functional decline and death within three months.ResultsFrailty was assessed in 95 % of 179 eligible patients. 45 % of patients experienced functional decline and 11 % died within three months. 40 % of patients were classified as vulnerable/mildly frail, and 41 % were moderately to severely frail. When patients in residential care were excluded, increasing frailty was associated with functional decline (p = 0.011). Increasing frailty was associated with increasing mortality within three months (p = 0.012).ConclusionsA high proportion of eligible patients had the frailty measure completed, demonstrating the acceptability of the CFS to clinicians. Despite lack of training for medical staff, increasing frailty was correlated with functional decline and mortality supporting the validity of the CFS as a frailty screening tool for clinicians.

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HighlightsMethods: MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies examining outcomes for hospitalised older adults. Included studies examined at least one potential individual health asset, which was a psychosocial characteristic or health characteristic. Study quality was assessed, and findings are narratively described.Results: Nine prospective cohort and two retrospective cohort studies were identified. subjective, functional and biological health assets were identified.Health assets were associated with decreased risk of post-hospital mortality, functional decline, new need for residential care and readmission. Conclusion:The complex interplay between health status and psychological and social factors is incompletely understood. Health assets are associated with improved outcomes for hospitalised older adults. The small number of studies suitable for inclusion indicates the need for further research in this area.

Background In July 2020, a COVID‐19 outbreak was recognised in the geriatric wards at a subacute campus of the Royal Melbourne Hospital affecting patients and staff. Patients were also admitted to this site after diagnosis in residential care. Aims To describe the early symptoms and the outcomes of COVID‐19 in older adults. Methods Patients diagnosed with COVID‐19 at the facility in July or August 2020 were identified and their medical records were examined to identify symptoms present before and after their diagnosis and to determine their outcomes. Results Overall, 106 patients were identified as having COVID‐19, with median age of 84.3 years (range 41–104 years); 64 were diagnosed as hospital inpatients after a median length of stay of 49 days, 31 were transferred from residential aged care facilities with a known diagnosis and 11 were diagnosed after discharge. There were 95 patients included in an analysis of symptom type and timing onset. Overall, 61 (64.2%) were asymptomatic at the time of diagnosis of COVID‐19, having been diagnosed through screening initiated on site. Of these, 88.6% developed symptoms of COVID‐19 within 14 days. The most common initial symptom type was respiratory, but there was wide variation in presentation, including fever, gastrointestinal and neurological symptoms, many initially not recognised as being due to COVID‐19. Of 104 patients, 32 died within 30 days of diagnosis. Conclusions COVID‐19 diagnosis is challenging due to the variance in symptoms. In the context of an outbreak, asymptomatic screening can identify affected patients early in the disease course.

The inclusion of health assets in predictive models can improve prognostication and highlights potential interventions to improve outcomes for hospitalized older adults.

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Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes Design: Prospective cohort study Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty. Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.