Abstract
Introduction
Frailty is defined as “a condition characterised by loss of biological reserves, failure of physiological mechanisms and consequent increased risk of experiencing a range of adverse outcomes, including hospitalisation, longer length of inpatient stay, and delirium” [1-4]. We aim to investigate the association between baseline frailty and functional recovery amongst hospitalized older adults and its association with inpatient delirium.
Method
Retrospective analysis of patients admitted to a Geriatrics ward from August to November 2022. Interactions between clinical outcomes with age, length of stay (LOS), discharge destination, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated plus incidence of inpatient delirium.
Results
In total, 58 patients reviewed, mean age 78.8 (±15.1) years, 43 (74%) woman. 79% were admitted from their own home with 56% same discharge destination and 9% inpatient mortality. Median LOS in hospital was 13 days with 8 days on the Geriatrics ward. Mean CFS on admission compared to discharge was (4.9 vs 5.7 (p<0.001)), with no significant difference in CCI. There was a significant association between CFS and LOS, both overall and on the Geriatrics ward (P<0.001). 17 patients (29%) developed delirium, with increased LOS (45 days vs 9 (P<0.001)), increased CFS both on admission (5.9 vs 4.4 (p=0.002)) and discharge (7.4 vs 5.0 (p<0.001)) and were less likely to be discharged to their own home (33.3% vs 84.8% (p<0.001)).
Conclusion
Frailty is a powerful predictor for possible risk of deconditioning and is associated with longer acute hospital stay in our more vulnerable patients. The coexistence of frailty and delirium significantly increased the risk of a prolonged hospital stay. This indicates that a multidisciplinary approach to provide a comprehensive geriatric assessment, is necessary to decrease LOSand the incidence of adverse outcomes as during this time period we had limited specialist therapy staff on the ward
Comments
Very interesting
Thank you, relevant to us in the community/ primary care. We need to prevent more admissions!