Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care

Abstract

BackgroundA high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services.Patients and methodsA clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services.ResultsAfter adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052–0.164; P<0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131–0.400; P<0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085–0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395–1.178; P=0.170).ConclusionAcute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.

Cross-cultural adaptation and validation of the PRISMA-7 scale for European Portuguese

“…Frailty is an age-associated biological syndrome with multisystem down-dysregulation, reduced physiological reserves [7][8][9][10][11] and capacity to maintain homeostasis [1,[12][13][14][15][16][17], loss of cognitive function [18], functional decline [5,6], increased risk of being institutionalised [19] and vulnerability to stressors [9-11, 13-15, 20], risk of falls, disability, dependence [4,18], activity limitations, imminent death, hospitalisation, prolonged recovery and relapse [1,8,16,19,[21][22][23][24][25]. Frail older patients present a long clinical course of disease with intermittent episodes of decline and experiencing a lack of coping strategies when dealing with change and disruptions [2,19].…”

“…Interactions between physiological changes due to ageing, polypharmacy, multimorbidity and functional impairment are often complex [21].…”

“…A high percentage of frail older patients suffering from multimorbidity and recurrent acute illnesses is treated in specialised acute care units [5,6,8,21]. After discharge, older patients have a higher risk of mortality, and approximately one-third of older patients experience a loss of independence in self-care activities, including personal and instrumental activities of daily living, which are related with poor nutrition, loss of sphincter control, and decreased self-care and low mobility during hospitalisation [18,21].…”

“…A high percentage of frail older patients suffering from multimorbidity and recurrent acute illnesses is treated in specialised acute care units [5,6,8,21]. After discharge, older patients have a higher risk of mortality, and approximately one-third of older patients experience a loss of independence in self-care activities, including personal and instrumental activities of daily living, which are related with poor nutrition, loss of sphincter control, and decreased self-care and low mobility during hospitalisation [18,21]. Functional decline is associated with worse outcomes of health-related quality of life, less living at home, more re-hospitalisations and higher health costs, which result in the use of more expensive and intensive services and higher mortality [18,21,27].…”

Frailty assessment: clinical application in the hospital setting

“…In addition, for frail patients, management in an AGW was associated with lower mortality at 3 months (HR=0.55; 95% CI=0.32-0.96), lower risk of an increasing degree of frailty (OR=0.23; 95% CI=0.13-0.4), and lower risk of decline in activities of daily living (OR=0.093; 95% CI=0.052-0.164). 27,28…”