The predictive properties of frailty-rating scales in the acute medical unit

Abstract

Background: older people are at an increased risk of adverse outcomes following attendance at acute hospitals. Screening tools may help identify those most at risk. The objective of this study was to compare the predictive properties of five frailty-rating scales. Method: this was a secondary analysis of a cohort study involving participants aged 70 years and above attending two acute medical units in the East Midlands, UK. Participants were classified at baseline as frail or non-frail using five different frailty-rating scales. The ability of each scale to predict outcomes at 90 days (mortality, readmissions, institutionalisation, functional decline and a composite adverse outcome) was assessed using area under a receiver-operating characteristic curve (AUC). Results: six hundred and sixty-seven participants were studied. Frail participants according to all scales were associated with a significant increased risk of mortality [relative risk (RR) range 1.6-3.1], readmission (RR range 1.1-1.6), functional decline (RR range 1.2-2.1) and the composite adverse outcome (RR range 1.2-1.6). However, the predictive properties of the frailty-rating scales were poor, at best, for all outcomes assessed (AUC ranging from 0.44 to 0.69). Conclusion: frailty-rating scales alone are of limited use in risk stratifying older people being discharged from acute medical units.

Frailty risk in hospitalised older adults with and without diabetes mellitus

“…The overall 30‐day rehospitalisation rate in the present study (12.5%) is lower than national US estimates which range from 18% to 20% among Medicare recipients (Dungan, ; Oates et al., ). We found that frailty, and not DM, was significantly associated with 30‐day rehospitalisation, a finding that has been similarly noted in other research (Forti et al., ; Wou et al., ). Increasing healthcare costs are partly attributable to a small subset of patients, particularly those with chronic conditions such as DM, who are prone to disease exacerbation and repeated hospitalisations for treatment (Centers for Disease Control and Prevention (CDC), ); however, our study found that frailty was a better predictor of rehospitalisation than DM, and that disease state was not a driver of rehospitalisation.…”

“…To assess the extent of frailty in the sample of hospitalised older adults with and without DM, we determined that the prevalence of frailty was similarly high and not significantly different in patients with and without DM (74% with DM, 63% without DM). This figure falls at the upper limit of prevalence rates reported in other studies in medical inpatients, with ranges from 32% to 94% (Basic & Shanley, ; Forti et al., ; Joosten, Demuynck, Detroyer, & Milisen, ; Khandelwal et al., ; Wou et al., ). Similar findings were noted in a study that investigated frailty in older adults admitted to a geriatric medicine unit ( N = 427; 30% with DM), where thirteen different frailty and functional decline instruments were applied and the prevalence of frailty ranged from 24% to 75% (Dent et al., ).…”

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

“…Another study reported that risk models incorporating either the SOF index or the Fried score exhibited C statistics of only 0.61 for predicting falls in elderly females. A cohort study from 2 English general medical units also found that none of the 5 frailty models was particularly accurate at predicting risk of readmission at 3 months, with C statistics ranging between 0.52 and 0.57. Although frailty assessment at time of hospital admission predicted in‐hospital mortality and length of stay in another English study, it was not independently associated with 30‐day outcomes after adjusting for age, sex, and comorbidities including dementia .…”

“…A cohort study from 2 English general medical units also found that none of the 5 frailty models was particularly accurate at predicting risk of readmission at 3 months, with C statistics ranging between 0.52 and 0.57. Although frailty assessment at time of hospital admission predicted in‐hospital mortality and length of stay in another English study, it was not independently associated with 30‐day outcomes after adjusting for age, sex, and comorbidities including dementia . To our knowledge, these latter 2 are the only other studies reported to date performed in hospitalized patients to assess whether frailty assessment helps predict postdischarge outcomes.…”

Changes in prevalence of diabetic complications and associated healthcare costs during a 10-year follow-up period among a nationwide diabetic cohort

“…This claim database has been reviewed routinely by the National Health Insurance Administration (NHIA) of Taiwan to ensure its completeness and accuracy. It has been the source for numerous epidemiological, healthcare and economic researches published in peer-reviewed journals (Lin et al, 2001;Lin et al, 2004;Lin, Huang, Wang, Yang, & Yaung, 2010;Wou et al, 2013).…”