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Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Citation

Subramaniam, A and Tiruvoipati, R and Green, C and Srikanth, V and Hussain, F and Soh, L and Yeoh, AC and Bailey, M and Pilcher, D, Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients, Internal Medicine Journal pp. 1-21. ISSN 1444-0903 (2020) [Refereed Article]


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Copyright Statement

Copyright 2020 Royal Australasian College of Physicians. This is the peer reviewed version of the following article, which has been published in final form at http://dx.doi.org/10.1111/imj.15032. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

DOI: doi:10.1111/imj.15032

Abstract

Objective: Hospitalised frail older patients are at risk of clinical deterioration. Early goals of care documentation (GOC) is vital to avoid futile/unwarranted interventions in the event of deterioration. We aimed to investigate the impact of frailty on timely GOC and its association with clinical outcomes in hospitalised older patients.

Design, setting, participants: Single-centre retrospective study of all medical patients aged ≥80 years admitted to acute medical unit between 1/3/2015 and 31/8/2015, with GOC derived from electronic records. Frailty was measured using Hospital Frailty Risk Score (HFRS) derived from hospital coding data.

Main outcome measures: Primary outcome compared proportions timely GOC within 72-h between frail (HFRS≥5) and non-frail (HFRS<5) patients. Exploratory secondary outcomes included in-hospital mortality, rapid response calls (RRCs), prolonged length of stay (LOS), and 28-day readmission rates.

Results: 529 (47.3%) of the 1118 admitted patients were frail. Timely GOC occurred in 50% (559/1118), more commonly in frail patients (283/529, 53.5%) than non-frail patients (276/589, 46.9%), p = 0.027. Frailty was positively associated with timely GOC independent of age and sex (OR = 1.28; 95%-CI = 1.01-163; p = 0.041). In univariable analyses, timely GOC was associated with greater in-hospital mortality, RRCs, and hospital LOS in both frail and non-frail patients (all p < 0.05); and greater 28-day readmissions only among frail patients (p = 0.028). Multivariable regression demonstrated timely GOC was associated only with in-hospital mortality in both frail and non-frail patients, independent of age and sex.

Conclusion: Older frail hospitalised patients were more likely to have timely GOC than older non-frail patients. Timely GOC in such patients may avoid burdensome treatments.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Geriatrics and gerontology
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Health related to ageing
UTAS Author:Srikanth, V (Dr Velandai Srikanth)
ID Code:141650
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-11-06
Last Modified:2020-12-11
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