Frailty in an Older Inpatient Population

Abstract

Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record

“…Further post hoc analyses suggested that the effects of the FRS on the study outcomes of time to in-hospital mortality and 30-day rehospitalization were not moderated by age (all p > .10). These findings correspond with those of prior studies (Basic & Shanley, 2015; Bellal et al, 2014; Santos-Eggimann, Cuénoud, Spagnoli, & Junod, 2009; Szanton, Allen, Seplaki, Bandeen-Roche, & Fried, 2009) and demonstrate that frailty is distinctly different from age and age-related changes that develop overtime in non-frail persons (Mansur, Colugnati, Grinsenkov, & Bastos, 2014). Further, the weak effect size we found between age and FRSs challenges the notion that frailty is unique to the aged.…”

“…Growing evidence suggests that the prevalence of frailty among hospitalized older adults is as high as 50 – 94%, depending on the instrument used (Basic & Shanley, 2015; Dent, Chapman, Howell, Piantadosi, & Visvanathan, 2014; Dent & Hoogendijk, 2014; Forti et al, 2014; Oo et al, 2013; Theou et al, 2013), and its deleterious consequences put an increased burden on patients, caregivers, and the healthcare system (Basic & Shanley, 2015; Joosten et al, 2014). In the present study, the prevalence of frailty was 68% based on a cut-off FRS of 9.…”

“…Frailty is a clinical syndrome characterized by multifactorial etiologies, vague symptom presentation, and vulnerability to adverse health outcomes that is disproportionate to the instigating stressors. There is evidence that frail older adults are more susceptible to the stresses of acute illness and hospitalization, are at greater risk for complications from treatment and surgery, and experience worse outcomes than persons who are not frail (Afilalo et al, 2014; Basic & Shanley, 2015; N. M. de Vries, Staal, van Ravensberg, Hobbelen, & Olde Rikkert, 2011).…”

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

“…(92) Frailty based on a multidimensional instrument was associated with a higher likelihood of death and institutional discharge, as well as greater health-care costs. (93–95) In an Australian study of older people hospitalized with an acute illness, the CSHA Clinical Frailty Scale predicted in-hospital mortality, new nursing home placement, and a longer hospital stay, (96) while a UK study found that a modified CSHA Clinical Frailty Scale (i.e., 9-point version) in adjusted analyses was an independent predictor of in-patient mortality, transfer to the geriatric service, and a length of stay of 10 or more days. (97) Another study using the 9-point version of the scale reported that moderate to severe frailty was an independent predictor of readmission to hospital or death within 30 days of discharge (adjusted OR 2.19, 95% CI 1.12–4.24).…”

Prescribing for frail older people

“…Frailty increases with age -15.7% of adults aged 80-84 years were identified as frail compared with 26.1% of those aged 85 years and over. 2 Frailty is very common in Australian acute geriatric medicine inpatients (approximately 90%) 3 and in residents of aged-care facilities (approximately 40%, depending on country studied and scale used). 4 Frailty is a dynamic state and people can move in and out of it.…”