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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]
 | PDF (Accepted Article) Available from 07 September 2021 2Mb |
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.
Abstract
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 |
| Downloads: | 0 |
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