Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Choi, Jung Yeon; Kim, Sun Wook; Yoon, Seung Hwan; Kang, Min Gu; Kim, Kwang Il; Kim, Cheol Ho

doi:10.2147/cia.s181400

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…A Korean study found that frailty was independently associated with do-not-resuscitate orders and healthcare transitions, even after adjusting for sepsis and pneumonia severity. 38 An international multidisciplinary group proposed a CGA 39 adapted to the emergency department context to assess frailty in elderly patients. 16 40 Although many physicians and intensivists do not currently perform CGAs in critically ill patients with infectious diseases, demographic shifts may require addressing this issue promptly.…”

Section: Discussionmentioning

confidence: 99%

Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

et al. 2020

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ObjectivesThis study evaluates the impact of frailty, which is a state of increased vulnerability to stressors, on 30-day and 1-year mortality among elderly patients with community-acquired pneumonia (CAP). The main hypothesis is that frailty is an independent predictor of prognosis in elderly CAP patients.DesignProspective, observational, follow-up cohort study.SettingA 2000-bed tertiary care hospital in Beijing, China.ParticipantsConsecutive CAP patients aged ≥65 years admitted to the geriatric department of our hospital between September 2017 and February 2019.Main outcome measuresThe primary outcomes were all-cause mortality at 30 days and 1 year after hospital admission. The impact of frailty (defined by frailty phenotype) on 30-day and 1-year mortality of elderly patients with CAP was assessed by Cox regression analysis.ResultsThe cohort included 256 patients. The median (IQR) age was 86 (81–90) years, and 180 (70.3%) participants were men. A total of 171/256 (66.8%) patients were frail. The prevalence of frailty was significantly associated with older age, female gender, lower body mass index, comorbidities, limitations in activities of daily living (ADLs) and poor nutritional status. Frail participants were significantly more likely to have severe CAP (SCAP) than non-frail counterparts (28.65% vs 9.41%, p<0.001). The 1-year mortality risk was approximately threefold higher in frail patients (adjusted HR, 2.70; 95% CI, 1.69 to 4.39) than non-frail patients. Subgroup analysis of patients with SCAP showed that the 1-year mortality risk was approximately threefold higher in the frail group (adjusted HR, 2.87; 95% CI, 1.58 to 4.96) than in the non-frail group. The association between frailty and 30-day mortality was not significant.ConclusionsThese findings suggest that frailty is strongly associated with SCAP and higher 1-year mortality in elderly patients with CAP, and frailty should be detected early to improve the management of these patients.

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Section: Discussionmentioning

confidence: 99%

Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

et al. 2020

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“…This shows that despite DNR/POLST guidelines, approaches to end-of-life care can vary greatly depending on local medical practices and patient conditions. The variability in ICU and in-hospital mortality and length of stay seen in several studies [ 5 , 19 , 20 , 22 ] further emphasizes the complexity of these decisions and their consequences in different settings.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Lee,

Ju,

Kang

et al. 2024

BMC Palliat Care

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Background In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. Methods We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. Results A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality. Conclusions Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.

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“…and cost-related variables could not be considered in our study. Institutionalization is one of the associated outcomes of frailty, and a previous study conducted in Korea revealed that frailty was linked to healthcare settings transitions from home to institutions in pneumonia patients 30 . In addition, only out-of-pocket healthcare costs were available in this study, thus we could not include important cost variables such as global health care costs.…”

Section: Discussionmentioning

confidence: 99%

Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea

Nari,

Park,

Nam

et al. 2023

Sci Rep

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Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008–2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37–1.69) and severe risk group (HR: 3.10, 95% CI: 2.55–3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0–35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.

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Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Cited by 9 publications

References 25 publications

Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea

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