Comparing three different measures of frailty in medical inpatients: Multicenter prospective cohort study examining 30‐day risk of readmission or death

Belga, Sara; Majumdar, Sumit R.; Kahlon, Sharry; Pederson, Jenelle L.; Lau, Darren; Padwal, Raj; Forhan, Mary; Bakal, Jeffrey A.; McAlister, Finlay A.

doi:10.1002/jhm.2607

Cited by 34 publications

(23 citation statements)

References 29 publications

(59 reference statements)

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“…26 Similarly, after classification of 72 older patients undergoing colorectal surgery on the basis of 7 frailty traits, 30-day readmission rates rose with increasing frailty from 6% to 29%. 27 Among nonsurgical patients, a Clinical Frailty Scale score of 5 or higher independently predicted a threefold risk of 30-day readmission or death among 245 older medical patients 17 and a twofold risk of 1-year readmission among 421 critically ill older patients. 5 In this study, we overcame several limitations of prior studies by enrolling an older but largely unselected surgical cohort and reporting outcomes that occurred as long as 6 months after discharge.…”

Section: Discussionmentioning

confidence: 99%

“…However, we enrolled a diverse cohort and we were more interested in less severely frail patients who are amenable to preventive strategies. Although we did not compare different tools or assess more objective frailty measures, we selected a frailty tool that is easy to use, reliable and predictive of clinically relevant outcomes, [16][17][18] and that has been recommended for use in other surgical populations. 13 We did not assess long-term disability or quality of life, which may be of particular importance to clinicians and patients.…”

Section: Limitationsmentioning

confidence: 99%

“…6 The Canadian Study of Health and Aging Clinical Frailty Scale 15 is a previously validated 9-point global subjective assessment of comorbidity and function that does not require specialized training or entail extensive assessment; 16 it has surpassed more complex frailty assessments in predicting readmission and mortality. 17,18 Very few studies have examined the risk associated with frailty for subsequent health care utilization in any surgical group. 18 Therefore, we assessed the impact of preadmission frailty on 30-day and 6-month readmission or death in older patients undergoing emergency abdominal surgery.…”

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confidence: 99%

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Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Pederson

Churchill

et al. 2018

CMAJ

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Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. METHODS:We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as "well" (score 1 or 2), "vulnerable" (score 3 or 4) or "frail" (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression. (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01-4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32-8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well. INTERPRETATION:Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission. Trial registration for primary study: ClinicalTrials. gov, no. NCT02233153

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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confidence: 99%

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Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Pederson

Churchill

et al. 2018

CMAJ

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“…Previous studies found independence rates between 15 and 73% at this time point 5,16,17 . The rates can differ depending on the population studied and the research location, as was found in a study that found a prevalence of independence in BADL of 75% in patients aged over 55 years 5 and another that evaluated the elderly aged over 65 years and study that evaluated the elderly based on two sets of criteria, the CFS and Fried, found that frailty was related to a loss of functional capacity and worse outcomes, such as hospital readmission and death 23 . As in previous studies, it was observed that frailty, evaluated by the Fried criteria, was associated with a loss of functionality.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of frailty is described as a risk factor for loss of functional capacity, hospitalization and death in the elderly living in the community 21,22 and death in hospitalized elderly persons 23 . Gregorevic et al 24 , using the Clinical Frailty Scale (CFS) in the evaluation of frailty in hospitalized elderly persons, observed that frail elderly individuals had a greater risk of functional loss, post-discharge institutionalization and death.…”

Section: Discussionmentioning

confidence: 99%

Impact of hospitalization on the functional capacity of the elderly: A cohort study

Carvalho

Valle

Jacinto

et al. 2018

Rev. bras. geriatr. gerontol.

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Objective: To verify the trajectory of the functional capacity of elderly persons hospitalized due to clinical conditions in a university hospital. Method: A descriptive, prospective cohort study was conducted between 2015 and 2016. Elderly patients admitted to the Hospital das Clínicas of Botucatu Medical School (Unesp), Brazil, were evaluated for the functional assessment of basic activities of daily living (BADL) using the Katz scale, nutritional status (body mass index (BMI)) and presence of the Frailty Syndrome (FS) (Fried criteria). A description of the trajectory of functional capacity was carried out at four times: 15 days before admission (T0), at admission (T1), at hospital discharge (T2) and 30 days after discharge (T3). Results: 99 elderly people with a mean age of 74 (+7.35) years, 59.6% of whom were male, were evaluated. Of these, 81.8% presented functional independence at T0, 45.5% at T1, 57.6% at T2 and 72.8% at T3. According to their functional trajectories, 28.2% of the elderly lost functional capacity between T0 and T3. There was an association between worsening of functional capacity between T0 and T3 and the FS (RR 4.56; p=0.003). Conclusion: Elderly patients have worse functional capacity at hospital discharge than before hospitalization. About 28.0% of the elderly had worse functional capacity 30 days after discharge than 15 days before admission. The elderly with Frailty Syndrome have a greater risk for worse functional capacity results 30 days after discharge.

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Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge

et al. 2019

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IMPORTANCE Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization.OBJECTIVE To investigate the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, patients 65 years and older with hypertension who were hospitalized in Veterans Health Administration national health system facilities from January 1, 2011, to December 31, 2013, for common noncardiac conditions were studied. Data analysis was performed from October 1, 2018, to March 10, 2019.EXPOSURES Discharge with antihypertensive intensification, defined as receiving a prescription at hospital discharge for a new or higher-dose antihypertensive than was being used before hospitalization. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not receive antihypertensive intensifications at hospital discharge. MAIN OUTCOMES AND MEASURESThe primary outcomes of hospital readmission, serious adverse events, and cardiovascular events were assessed by competing risk analysis. The secondary outcome was the change in systolic BP within 1 year of hospital discharge. RESULTSThe propensity-matched cohort included 4056 hospitalized older adults with hypertension (mean [SD] age, 77 [8] years; 3961 men [97.7%]), equally split between those who did vs did not receive antihypertensive intensifications at hospital discharge. Groups were well matched on all baseline covariates (all standardized mean differences <0.1). Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1. NNH, 63; 95% CI,. At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, −2.4 to 3.7 mm Hg).CONCLUSIONS AND RELEVANCE Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.

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Comparing three different measures of frailty in medical inpatients: Multicenter prospective cohort study examining 30‐day risk of readmission or death

Cited by 34 publications

References 29 publications

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Impact of hospitalization on the functional capacity of the elderly: A cohort study

Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge

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