Association Between Patient‐Reported Frailty and Non‐Home Discharge Among Older Adults Undergoing Surgery

Abstract

BACKGROUND/OBJECTIVES Identifying surgical patients at risk for discharge to a post‐acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient‐reported frailty screen and non‐home discharge (NHD). DESIGN Prospective cohort. SETTING Urban tertiary academic preoperative evaluation center. PARTICIPANTS Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3 days or longer. METHODS Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient‐reported items and NHD. RESULTS A total of 230 patients were included for analysis. The average age of the cohort was 70.1 (standard deviation = 7.1); 91.7% were White, and 52.4% were female. There were 24 patients (10.4%) who were not discharged home. They were more likely to report fatigue (54% vs 29%; P = .01), weight loss (58% vs 21%; P < .01), and difficulty with activity against resistance (33% vs 7%; P < .01) before surgery. In adjusted analysis, patients who self‐reported frailty (FRAIL screen ≥2) were significantly more likely to have an NHD (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.7–11.7; P < .01), as were patients who responded “yes” to any question from the FRAIL screen (OR = 2.5; 95% CI = 1.7–3.5; P < .01). A positive response to difficulty with activity against resistance or recent weight loss showed similar odds of NHD (OR = 7.6; 95% CI = 2.6–23.9; P < .01; and OR = 7.9; 95% CI = 2.9–21.6; P < .01, respectively). Conclusion Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.

Predictive Abilities of the Frailty Phenotype and the Swiss Frailty Network and Repository Frailty Index for Non-Home Discharge and Functional Decline in Hospitalized Geriatric Patients

“…We also found that both the SFNR-frailty index and frailty phenotype were predictive for non-home discharge, which is in accordance to prior studies, but in other clinical settings ( 10 , 16 ). In a primary care setting, an electronic frailty index using routine data to identify frailty was predictive for a combined endpoint of mortality, hospitalization and nursing home admission ( 16 ).…”

“…In a primary care setting, an electronic frailty index using routine data to identify frailty was predictive for a combined endpoint of mortality, hospitalization and nursing home admission ( 16 ). Similarly, Sokas et al ( 10 ) reported an association of patient-reported frailty and non-home discharge among older adults undergoing surgery. Our study adds to the literature, that both frailty tools predict non-home discharge in acute care geriatric patients.…”

“…Consequently, in addition to treating the acute illness, care goals need to also focus on preservation or improvement of functional status to facilitate discharge to home and maintain quality of life of patients ( 8 ). Therefore, non-home discharge and functional decline are considered clinically relevant outcomes in the acutely hospitalized geriatric patients ( 9 , 10 ). To identify patients at particular risk of these outcomes, clinical prediction models would be helpful to identify high risk patients for non-home discharge and functional decline upon admission and guide treatment and early discharge planning.…”

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

“… 30 Another study found both frail (25.9%) and prefrail (26.9%) participants to have higher odds of a fall compared to nonfrail participants (13.4%). 26 Results for functional outcomes were not pooled due to the heterogeneity of the outcomes.…”

Simple preoperative frailty screening may identify older people with increased needs for discharge planning post surgery

“…The aim of this cohort study3 was to investigate any association between frailty and discharge destination in a convenience sample of older adults, aged 60 and over, undergoing elective major abdominal surgery that was expected to require an acute hospital stay of 3 or more days. Screening for frailty involved completion of four questions from the FRAIL screening tool,4 where participants self-reported their fatigue, weight loss, ambulation ability and activity against resistance (ability to climb stairs).…”