Allocating patients to geriatric medicine wards in a tertiary university hospital in England: A service evaluation of the Specialist Advice for the Frail Elderly (SAFE) team

Abstract

The number of older patients admitted to acute hospitals has increased; however, their needs are heterogeneous and there is no gold‐standard method of triaging them towards practicing comprehensive geriatric assessment (CGA). In our hospital, the SAFE (Specialist Advice for the Frail Elderly) team provide an initial geriatric assessment of all emergency admissions of patients aged ≥75 years (with some assessments also occurring in those aged 65 to 74 years) and recommend as to whether CGA in a dedicated Department of Medicine for the Elderly (DME) ward may be required. SAFE assessments include routine screening for geriatric syndromes using validated tools. Our aim was to compare the characteristics (age, gender, acute illness severity on admission as per modified early warning score (MEWS), Charlson Comorbidity Index, Clinical Frailty Scale (CFS), presence of dementia and delirium) and outcomes (length of stay, delayed discharge, inpatient mortality, discharge to usual place of residence, and new institutionalization) of patients listed to a DME ward, to those not listed. We analyzed all SAFE team assessments of patients admitted nonelectively between February 2015 and November 2016. Of 6192 admissions, 16% were listed for a DME ward. Those were older, had higher MEWS and CFS score, were more often affected by cognitive impairment, had longer hospital stay, higher inpatient mortality, and more often required new institutionalization. Higher CFS and presence of dementia and delirium were the strongest predictors of DME ward recommendation. Routine measurement of markers of geriatric complexity may help maximize access to finite inpatient CGA resources.

Factors associated with shorter length of admission among people with dementia in England and Wales: retrospective cohort study

“…These findings may reflect the complex mental, physical and social needs of people admitted to specialist wards. 25 The association between BAME background and shorter length of stay was unexpected and require further investigation.…”

“…These findings may reflect the complex mental, physical and social needs of people admitted to specialist wards. 25 …”

Validation of the revised 9-scale clinical frailty scale (CFS) in Greek language

“…Later, it was expanded from a 7-point scale to the present 9-point scale [ 8 ] and recently was further revised with minor edits to the level descriptions and their corresponding labels [ 9 ]. It has been largely used to assess the overall level of fitness or frailty in hospitalized [ 10 – 14 ], institutionalized [ 15 – 17 ] and community-dwelling [ 6 , 7 ] older adults and in elderly patients admitted to intensive care units [ 18 – 20 ] or evaluated at emergency departments [ 21 – 23 ].…”

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis

“… 217 Multicenter and prospective cohort study 75 frail and age 72 non-frail people KC ††† (Frail≥8) ICDSC *** Prevalence of frailty HR ‡ 0.29 (0.23 - 0.35) Prevalence of delirium HR ‡ 0.12 (0.09 - 0.17) Risk of delirium in frail patients RR § 6.52 (1.79 - 23.78) Giroux, et al, 2018 9 Canada Emergency Sector To evaluate if frailty screening in older adults in the Emergency Department can help identify the risk of delirium . 335 Prospective cohort study 76.8±8.1 CFS ‡‡‡ (Frail>5/7) CAM † Prevalence of frailty HR ‡ 0.21 (0.17 - 0.26) Prevalence of delirium HR ‡ 0.12 (0.09 - 0.16) Risk of delirium in frail patients RR § 3.79 (2.16 - 6.63) Alabaf Sabbaghi, et al, 2018 31 United Kingdom Emergency Sector To compare the clinical characteristics, frailty, dementia and delirium in a hospital with a specialized counseling team for frail older adults versus usual treatment. 6,191 Retrospective and documentary 84.6±6.3 CFS ‡‡‡ 4-ATM §§§ Prevalence of frailty HR ‡ 0.05 (0.04 - 0.06) Prevalence of delirium HR ‡ 0.12 (0.11 - 0.13) Nomura, et al, 2018 32 Japan Cardiac surgery To examine the hypothesis that baseline frailty would be associated with postoperative delirium and to cognitive changes from 1 to 12 months after a cardiac surgery.…”