The association of geriatric syndromes with hospital outcomes

Background

Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital.

Objective

To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery).

Design

Retrospective observational study.

Setting

Large university hospital in England.

Patients

We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015.

Measurements

The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30-day readmission. Statistical analyses were based on multivariate regression models.

Results

Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval [CI], 1.36-1.77; P < 0.001; HoD: OR = 2.16; 95% CI, 1.79-2.61; P < 0.001; and ACS: OR = 3.31; 95% CI, 2.64-4.15; P < 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79-2.94; P < 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27-1.67; P < 0.001; HoD: OR = 2.17; 95% CI, 1.80-2.62; P < 0.001; and ACS: OR = 2.29; 95% CI: 1.83-2.85; P < 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09-3.14; P < 0.001; HoD: OR = 2.51; 95% CI, 2.00-3.14; P < 0.001; and ACS: OR 1.93; 95% CI, 1.46-2.56; P < 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09-1.71; P = 0.006.

Conclusions

Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults. Journal of Hospital Medicine 2017;12:83-89. © 2017 Society of Hospital Medicine