Geriatric Consultation of Frail Patients in Internal Medicine Service and its association with hospital mortality, hospital stay and Intensive Care Unit admission. An observational study.

Abstract

Objective: The main objective is to describe the association between monodisciplinary management led by the attending physician without geriatric intervention and the involvement of geriatrics as consultants for frail patients over 65 years old admitted to the internal medicine service. This assessment is based on patient outcomes, inpatient length of stay, percentage of admissions to intensive care unit, and in-hospital mortality. Methods and Analysis: A prospective observational study was conducted in which all fragile patients over 65 years old admitted to internal medicine ward from March to November 2022 in two hospitals in northern Mexico were included. The outcomes were compared between the group of patients who received routine monodisciplinary management by their attending physician during hospitalization without the participation of a geriatrician, and those who had collaborative management with geriatrics as consultant. No interventions or suggestions were made to any of the groups assessed. Frailty stratification was performed on patients with the FRAIL scale. Results: A total of 111 patients were included with a mean age of 80.6 ± 7.9 years. Out of the total patients, 60 (54.1%) received management from their treating physician along with a geriatrician as a consultant, and the remaining 51 only received monodisciplinary management from their treating physician. There was an association between monodisciplinary management and longer in-hospital stay, compared to the patients who received medical management along with Geriatrics (13.4 vs 5.8 days, P=<0.0001). 29% had a prolonged in-hospital stay, defined as longer than 9 days, and 84.8% of them had monodisciplinary management without Geriatrics consultation (84.8% vs 15.2%, P=<0.005). Of the patients under study, 17.1% died during hospitalization. The mortality in patients consulted by geriatrics was lower, however this association was not statistically significant (47.4% vs 52.6%, P=0.521). Conclusion: The support of the geriatric physician in the in-hospital medical management of the frail elderly patient is significantly associated with a reduction in the length of in-hospital stay and rate of critical care unit admissions. It was not significantly associated with lower mortality; however this could be explained by the inherent nature of frailty as an unfavorable prognostic factor.