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Poor outcomes of even brief hospital admissions among frail older people: a role for secondary prevention of frailty crises in the community?

Poor outcomes of even brief hospital admissions among frail older people: a role for secondary prevention of frailty crises in the community?
Poor outcomes of even brief hospital admissions among frail older people: a role for secondary prevention of frailty crises in the community?
Background ‘Frailty crises’ are a common cause of hospital admission amongst 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 is 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 (<72h) and longer hospital admissions compared by frailty status. Design and Setting Two populations aged >=70 years discharged from hospital units (i) following short ‘ambulatory’ admissions (<72h); (ii) following longer in-patient stays. Method Two-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data. Results Mortality after two years was increased for frail compared to non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood HR 2.3 [1.5, 3.4]) and hospital use (Rockwood RR 2.1 [1.7, 2.6]) compared to the non-frail. Conclusions 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 which 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.
Frailty, Intermediate care, hospitalisation, ambulatory care, geriatric assessment, PRIMARY CARE
Keeble, Eilis
20e82708-71f4-4216-9d8a-21eea95718e7
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Williams, Christopher
aa94de52-67d5-40df-9be8-063d2ed349c4
Van Oppen, James
e8a060ba-2f57-4ded-b802-79a2624a79c0
Conroy, Simon
7ca24494-cca8-4846-b5ea-f79d1f7dedfa
Keeble, Eilis
20e82708-71f4-4216-9d8a-21eea95718e7
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Williams, Christopher
aa94de52-67d5-40df-9be8-063d2ed349c4
Van Oppen, James
e8a060ba-2f57-4ded-b802-79a2624a79c0
Conroy, Simon
7ca24494-cca8-4846-b5ea-f79d1f7dedfa

Keeble, Eilis, Roberts, Helen, Williams, Christopher, Van Oppen, James and Conroy, Simon (2019) Poor outcomes of even brief hospital admissions among frail older people: a role for secondary prevention of frailty crises in the community? British Journal of General Practice. (In Press)

Record type: Article

Abstract

Background ‘Frailty crises’ are a common cause of hospital admission amongst 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 is 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 (<72h) and longer hospital admissions compared by frailty status. Design and Setting Two populations aged >=70 years discharged from hospital units (i) following short ‘ambulatory’ admissions (<72h); (ii) following longer in-patient stays. Method Two-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data. Results Mortality after two years was increased for frail compared to non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood HR 2.3 [1.5, 3.4]) and hospital use (Rockwood RR 2.1 [1.7, 2.6]) compared to the non-frail. Conclusions 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 which 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.

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Accepted/In Press date: 26 February 2019
Keywords: Frailty, Intermediate care, hospitalisation, ambulatory care, geriatric assessment, PRIMARY CARE

Identifiers

Local EPrints ID: 430002
URI: https://eprints.soton.ac.uk/id/eprint/430002
PURE UUID: a9ac1de3-e932-40e2-a7e2-3cfa14b30caf
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 09 Apr 2019 16:30
Last modified: 14 Jun 2019 00:36

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Contributors

Author: Eilis Keeble
Author: Helen Roberts ORCID iD
Author: Christopher Williams
Author: James Van Oppen
Author: Simon Conroy

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