Quantifying the prevalence of frailty in English hospitals

Abstract

Objectives: Population ageing has been associated with an increase in comorbid chronic disease, functional dependence, disability and associated higher health care costs. Frailty Syndromes have been proposed as a way to define this group within older persons. We explore whether frailty syndromes are a reliable methodology to quantify clinically significant frailty within hospital settings, and measure trends and geospatial variation using English secondary care data set Hospital Episode Statistics (HES).

Setting: National English Secondary Care Administrative Data HES.

Participants: All 50,540,141 patient spells for patients over 65 years admitted to acute provider hospitals in England (January 2005-March 2013) within HES.

Primary and secondary outcome measures: We explore the prevalence of Frailty Syndromes as coded by International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) over time, and their geographic distribution across England. We examine national trends for admission spells, inpatient mortality and 30-day readmission.

Results: A rising trend of admission spells was noted from January 2005 to March 2013 (daily average admissions for month rising from over 2000 to over 4000). The overall prevalence of coded frailty is increasing (64,559 spells in January 2005 to 150,085 spells by Jan 2013). The majority of patients had a single frailty syndrome coded (10.2% vs total burden of 13.9%). Cognitive impairment and falls (including significant fracture) are the most common frailty syndromes coded within HES. Geographic variation in frailty burden was in keeping with known distribution of prevalence of the English elderly population and location of National Health Service (NHS) acute provider sites. Overtime, in-hospital mortality has decreased (>65 years) whereas readmission rates have increased (esp.>85 years).

Conclusions: This study provides a novel methodology to reliably quantify clinically significant frailty. Applications include evaluation of health service improvement over time, risk stratification and optimisation of services.

Keywords: Acute; Ageing; England; Frailty; HES; Prevalence.

Figure 1

(A) Daily average admission spells for month and percentage total frailty burden for England NHS acute trusts. (B) The number and percentage of spells for patients >65 years by age-band admitted to English acute providers. LNPL, Lower Natural Process Limits; NHS, National Health Service; UNPL, Upper Natural Process Limits.

Figure 2

The percentage of admissions to English acute providers coded with at least one frailty syndrome. LNPL, Lower Natural Process Limits; UNPL, Upper Natural Process Limits.

Figure 3

Trends for the prevalence of count of frailty syndromes and total frailty burden for patients >65 years admitted to NHS acute provider hospitals between April 2006 and December 2012. NHS, National Health Service.

Figure 4

Trends for the prevalence of frailty syndromes for patients >65 years admitted to NHS acute provider hospitals between January 2005 and March 2013. NHS, National Health Service.

Figure 5

Percentage of spells for patients >65 years with admission to NHS acute trusts with at least one frailty syndrome by PCT by quintiles (numerator=admission spells with at least one frailty syndrome; denominator=total admission spells to NHS acute trusts within English PCT). NHS, National Health Service; PCT, Primary Care Trust.

Figure 6

(A) Percentage of spells with inpatient mortality admitted to English providers and (B) non-elective 30-day readmission in patients >65 years admitted to English acute providers.

Figure 7

Number and percentage non-elective readmissions in patient >65 years admitted to NHS acute providers by age-band. NHS, National Health Service.