Outcomes of hospital admissions among frail older people: a 2-year cohort study

Abstract

Background: 'Frailty crises' are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty.

Aim: To determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status.

Design and setting: Two populations aged ≥70 years discharged from hospital units: those following short 'ambulatory' admissions (<72 hours) and those following longer inpatient stays.

Method: Data for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data.

Results: Mortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail.

Conclusion: Individuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short 'ambulatory' admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a 'secondary prevention' approach to frailty crises targeting individuals who are discharged from hospital.

Keywords: ambulatory care; frailty; geriatric assessment; hospitalisation; intermediate care; primary care.