137 Does the Clinical Frailty Scale Predict Rehabilitation Potential in Older Patients?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Maeve D'Alton ◽  
Joanne Larkin ◽  
Avril McKeag ◽  
Grace Coakley ◽  
Emma Nolan ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Outcome Measure ◽  
Discharge Planning ◽  
Functional Independence ◽  
Discharge Destination ◽  
Clinical Frailty Scale ◽  
Common Diagnosis ◽  
Rehabilitation Potential ◽  
Surgical Admission

Abstract Background The Clinical Frailty Scale (CFS) is widely used to assess frailty in older adults and reflects functional independence. We examined its use as an outcome measure in an offsite rehabilitation unit for patients over 65 transferred from an acute hospital following medical/surgical admission. Methods Patients were given a CFS score by consensus opinion from the multidisciplinary team on admission and on completion of rehabilitation. We included data on diagnosis, length of stay and discharge destination Results Thirty patients, with a mean age of 80, completed rehabilitation over a four-month period. The most common diagnosis was fracture of hip or pelvis (53%). Median CFS was 6 on admission and 5 on discharge (range 3-8). Twenty-one (70%) patients saw an improvement in CFS of an average of one point on the scale irrespective of admission score. Of those that improved, 81% were discharged directly home with no need for increased support services, compared with 11% of those who did not improve. Mean length of stay was significantly less in those with mild/moderate frailty (CFS 5-6) at admission versus severe frailty (31 vs 53.8 days, p<0.01). Conclusion Frailty score improved in the majority of patients undergoing rehabilitation, regardless of admission score; CFS alone did not predict rehabilitation potential, emphasising the importance of offering rehabilitation to frail older adults – better judged by experienced clinical assessment. CFS is a broad 9-point tool that can miss small improvements in physical function based on other objective scores e.g. FIM+FAM. Severe frailty was associated with longer length of stay in rehabilitation, possibly reflecting more complex discharge planning as well as rehabilitation progress in this group.

513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
M Thomas ◽  
M Baltatzis ◽  
A Price ◽  
L Pearce ◽  
J Fox ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Cholangitis ◽  
Pancreatic Disease ◽  
Biliary Disease ◽  
Clinical Frailty Scale ◽  
Care Level ◽  
Frail Patients ◽  
Common Diagnosis ◽  
Endoscopic Cholangiopancreatography ◽  
Observational Cohort

Abstract Introduction The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay. Methods Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission. Results We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%). Conclusion Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.

scholarly journals 88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Edel McDaid ◽  
Elaine Ross ◽  
Lisa Cogan
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Long Term Care ◽  
Discharge Destination ◽  
Clinical Frailty Scale ◽  
Geriatric Population ◽  
Term Care ◽  
Geriatric Unit ◽  
Post Acute Care

Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.

scholarly journals 334 GEMS: Geriatric Emergency Service - Rockwood’s Clinical Frailty Scale and Outcomes

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Danielle Reddy ◽  
Grainne Gallagher ◽  
Maureen O'Callaghan ◽  
Lorna Cornally ◽  
Megan Hayes Brennan ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Older People ◽  
Patient Experience ◽  
Emergency Service ◽  
Strong Predictor ◽  
Canadian Study ◽  
Clinical Frailty Scale ◽  
Care Outcomes

Abstract Background Rockwood’s Clinical Frailty Scale (CFS), which uses clinical descriptors and pictographs, was developed to provide clinicians with an easily applicable tool to stratify older adults according to level of vulnerability. The CFS was validated in a sample of 2305 older participants from the Canadian Study of Health and Aging and was shown to be a strong predictor of institutionalisation and mortality (Rockwood K, 2005). Methods The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. At the end of CGA all patients have a score 1 to 9 assigned from the Clinical Frailty Scale (CFS). Results 10,037 patients were triaged in the first two years of the service. 43% screened positive for Frailty. 66% had a CGA. 10% were vulnerable CFS 4, 32% mildly frail CFS 5, 32% moderately frail CFS 6 and 31% severely frail CFS 7. Increasing score on the CFS correlated with increased length of stay, death and institutionalisation. Conclusion The CFS correlates with Length of stay (LOS), mortality and institutionalisation in people aged 75 years and older who attend as an emegency and screen positive for Frailty.

scholarly journals Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Adverse Outcomes ◽  
Point Prevalence ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
National Programme ◽  
Diagnostic And Statistical Manual ◽  
Multivariable Analyses ◽  
The Uk

Abstract Background Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes. Methods We conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions. Results The point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21). Conclusions Delirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

scholarly journals Factors associated with shorter length of admission among people with dementia in England and Wales: retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047255
Author(s):  
Rahil Sanatinia ◽  
Alistair Burns ◽  
Peter Crome ◽  
Fabiana Gordon ◽  
Chloe Hood ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Outcome Measure ◽  
Discharge Planning ◽  
Length Of Hospital Stay ◽  
England And Wales ◽  
People With Dementia

ObjectivesTo identify aspects of the organisation and delivery of acute inpatient services for people with dementia that are associated with shorter length of hospital stay.Design and settingRetrospective cohort study of patients admitted to 200 general hospitals in England and Wales.Participants10 106 people with dementia who took part in the third round of National Audit of Dementia.Main outcome measureLength of admission to hospital.ResultsThe median length of stay was 12 days (IQR=6–23 days). People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission (estimated effect −0.24, 95% CI: −0.29 to −0.18, p<0.001). People from ethnic minorities had shorter length of stay (difference −0.066, 95% CI: −0.13 to −0.002, p=0.043). Patients with documented evidence of discussions having taken place between their carers and medical staff spent longer in hospital (difference 0.26, 95% CI: 0.21 to 0.32, p<0.001). These associations held true in a subsample of 669 patients admitted with hip fracture and data from 74 hospitals with above average carer-rated quality of care.ConclusionsThe way that services for inpatients with dementia are delivered can influence how long they spend in hospital. Initiating discharge planning within the first 24 hours of admission may help reduce the amount of time that people with dementia spend in hospital.

scholarly journals Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study

2020 ◽  
Vol 17 (24) ◽  
pp. 9490
Author(s):  
Fabrizio Bert ◽  
Omar Kakaa ◽  
Alessio Corradi ◽  
Annamaria Mascaro ◽  
Stefano Roggero ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Regression Models ◽  
Discharge Planning ◽  
Surgical Site Infections ◽  
Social Risk ◽  
Discharge Destination ◽  
Social Risk Factors ◽  
Logistic Regression Models ◽  
Expected Length

Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that can predict a longer-than-expected length of stay or the need for a discharge with additional needs can improve this process. A cohort study was conducted in the largest hospital of Northern Italy, collecting discharge records from January 2017 to January 2020 and pre-admission visits in the last three months. Socio-demographic and clinical data were collected. Linear and logistic regression models were fitted. The main outcomes were the length of stay (LOS) and discharge destination. The main predictors of a longer LOS were the need for additional care at discharge (+10.76 days), hospitalization from the emergency department (ED) (+5.21 days), and age (+0.04 days per year), accounting for clinical variables (p < 0.001 for all variables). Each year of age and hospitalization from the ED were associated with a higher probability of needing additional care at discharge (OR 1.02 and 1.77, respectively, p < 0.001). No additional findings came from pre-admission forms. Discharge difficulties seem to be related mainly to age and hospitalization procedures: those factors are probably masking underlying social risk factors that do not show up in patients with planned admissions.

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