Highlights
- •This was a retrospective observational study in a university hospital in England.
- •In 5505 older adults aged 75+ frailty and acuity independently predicted mortality.
- •Hospitals should undertake large scale assessment of frailty as well as acuity.
Abstract
Aim
Frail individuals may be at higher risk of death from a given acute illness severity
(AIS), but this relationship has not been studied in an English National Health Service
(NHS) acute hospital setting.
Methods
This was a retrospective observational study in a large university NHS hospital in
England. We analyzed all first non-elective inpatient episodes of people aged ≥75 years (all specialties) between October 2014 and October 2015. Pre-admission frailty
was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health
& Aging, and AIS in the Emergency Department was measured with a Modified Early Warning
Score (ED-MEWS < 4 was considered as low acuity, and ED-MEWS ≥ 4 as high acuity). A survival analysis compared times to 30-day inpatient death between
CFS categories (1–4: very fit to vulnerable, 5: mildly frail, 6: moderately frail,
and 7–8: severely or very severely frail).
Results
There were 12,282 non-elective patient episodes (8202 first episodes, of which complete
data was available for 5505). In a Cox proportional hazards model controlling for
age, gender, Charlson Comorbidity Index, history of dementia, current cognitive concern,
and discharging specialty (medical versus surgical), ED-MEWS ≥ 4 (HR = 2.87, 95% CI: 2.27–3.62, p < 0.001), and CFS 7–8 (compared to CFS 1–4, HR = 2.10, 95% CI: 1.52–2.92, p < 0.001) were independent predictors of survival time.
Conclusions
We found frailty and AIS independently associated with inpatient mortality after adjustment
for confounders. Hospitals may find it informative to undertake large scale assessment
of frailty (vulnerability), as well as AIS (stressor), in older patients admitted
to hospital as emergencies.
Keywords
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Article info
Publication history
Published online: September 02, 2016
Accepted:
August 29,
2016
Received in revised form:
August 9,
2016
Received:
June 9,
2016
Footnotes
☆Authors' contributions: Roman Romero-Ortuno conceived the study, collected and interpreted data, performed statistical analyses, and prepared the manuscript. Stephen Wallis and Richard Biram collected and interpreted data and revised the manuscript critically for important intellectual content. Victoria Keevil performed statistical analyses, interpreted data, and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript before submission.
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
