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

Ashwin Subramaniam, Ravindranath Tiruvoipati, Cameron Green, Velandai Srikanth, Lionel Soh, Aun Chian Yeoh, Faisal Hussain, Michael Bailey, David Pilcher

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8 Citations (Scopus)

Abstract

Background: Hospitalised frail older patients are at risk of clinical deterioration. Early goals of care (GOC) documentation is vital to avoid futile/unwarranted interventions in the event of deterioration. Aims: To investigate the impact of frailty on timely GOC and its association with clinical outcomes in hospitalised older patients. Methods: This was a single-centre retrospective study of all medical patients aged ≥80 years admitted to the acute medical unit between 1/3/2015 and 31/8/2015, with GOC derived from electronic records. Frailty was measured using the Hospital Frailty Risk Score (HFRS) derived from hospital coding data. Primary outcome compared proportions of 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 (RRC), prolonged length of stay (LOS) and 28-day readmission rates. Results: Of the 1118 admitted patients, 529 (47.3%) 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 gender (odds ratio = 1.28; 95% confidence interval = 1.01–163; P = 0.041). In univariable analyses, timely GOC was associated with greater in-hospital mortality, RRC, 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 that timely GOC was associated only with in-hospital mortality in both frail and non-frail patients, independent of age and gender. 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.

Original languageEnglish
Pages (from-to)2078-2086
Number of pages9
JournalInternal Medicine Journal
Volume51
Issue number12
DOIs
Publication statusPublished - Dec 2021

Keywords

  • elderly
  • frailty
  • goals of care
  • HFRS
  • hospital frailty risk score

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