Prevalence of frailty in a tertiary hospital: A point prevalence observational study

Abstract

Introduction Frailty is an important concept in modern healthcare due to its association with adverse outcomes. Its prevalence varies in the literature and there is a paucity of literature looking at the prevalence of frailty in an inpatient setting. Its significance lies on its impact on resource utilisation and costs. Aim To determine the prevalence of frailty in the adult population in a tertiary New Zealand hospital. Methods Eligible patients aged 18 years and over were invited to participate, and frailty assessment was performed using the Reported Edmonton Frail Scale. A score of 8 or more was considered frail. Factors associated with frailty were assessed. Results Of 640 occupied inpatient beds, 420 patients were assessed. 220 patients were excluded, of which 89 were absent from their bed-space, 73 declined and 41 were critically unwell. The overall prevalence of frailty across assessed patients was 48.8%. The prevalence of frailty increased significantly with age; patients aged 85 and over were significantly more likely to be frail compared to those aged under 65 (OR 6.25, 95% CI 3.17–12.7). Maori patients were significantly more likely to be frail (OR 4.0, 95% CI 1.45–11.9). When compared to those patients admitted to a medical specialty, patients admitted to surgical specialty were less likely to be frail (OR 0.52 95% CI 0.31–0.86) and those admitted for rehabilitation were more likely to be frail (OR 1.86 95% CI 1.03–3.41). Frail patients were more likely to come from a rest home (OR 2.81, 95% CI 1.38–6.14) or hospital level care (OR 9.62, 95% CI 2.68–61.6). Conclusion Frailty is highly prevalent in the hospital setting with 48.8% of all inpatients classified as frail. This high number of frail patients has significant resource implications and an increased understanding of the burden of frailty in this population may aid targeting of interventions towards this vulnerable population.

Advance care plans and hospitalized frail older adults: a systematic review

“…As a result, this systematic review reports on studies with a mean age of > 75 years and no disease-specific diagnosis. Such studies are likely to include a high proportion of frail patients,24 but the number of frail patients in each study and their level of frailty is unknown.…”

“…In view of this, the inclusion and exclusion criteria were developed to capture studies of mixed populations that would include a significant proportion of frail patients, as measured by a validated operationalisation of frailty, drawing on a previous systematic review in this area16 and reflecting other disease-specific reviews that have included mixed populations 23. A mean age criterion of 75 years was chosen in view of the strong correlation between frailty and older age (70% of hospitalised patients over the age of 75 years have been found to be frail),24 and this was combined with the absence of focus on a disease-specific terminal condition, for example, malignancy, organ failure or dementia. ACP was considered to be discussions with patients about their personal values, life goals and preferences regarding future medical care 21.…”

The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis

“…It can be the cause of incidents which worsen the frailty of older people [8]. The prevalence of frailty in geriatric inpatients, depending on the evaluation tool used, ranges from 48.8 to 80% [9,10]. Chen et al (2019) demonstrated that the prevalence of hospitalized frail older adults, evaluated with Fried's frailty phenotype, was 40% [11].…”

Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

“…However, these tools do not consider frailty—a clinical state of reduced physiologic reserve and increased vulnerability to poor health outcomes [ 12 ]—that is germane to clinical management of older adults. The prevalence of frailty ranges from 10 % in the community [ 13 ] to more than 50 % in the nursing homes [ 14 ] and hospitals [ 15 ], and it has been associated with poor health outcomes in the primary care [ 16 ], acute hospital [ 17 ], and critical care setting [ 18 ]. Therefore, assessing frailty on admission may provide information about patients’ vulnerability and prognosis that is not captured by the pneumonia severity and is useful to deliver patient-centered care to improve recovery.…”